Emergency Medicine Education

APRIL 11, 2022

Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock” This study was in Paris metropolitan region. The choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients.

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Epinephrine 40

Core EM

JANUARY 25, 2024

Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.

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Epinephrine Critical Care Emergency Department ED 188

REBEL EM

JUNE 14, 2023

to 0.5mg (1mg/mL) IV Bolus: 5 to 20mcg (10mcg/mL) IV Infusion: 1 to 20mcg/min If Poor Response to Conventional Therapy Consider Epinephrine 100mcg IV bolus Norepinephrine infusion 0.1mcg/kg/min Vasopressin 0.01

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Allergic Reaction Epinephrine OR EMS 131

University of Maryland Department of Emergency Med

JANUARY 30, 2023

When managing a hypotensive patient who may have some element of cardiogenic shock, it has long been debated whether it is better to start an. Click to view the rest

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Epinephrine 40

EMDocs

MARCH 9, 2024

1: Epinephrine or Airway First in OHCA? Spoon Feed In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. JAMA Netw Open.

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Epinephrine EMS OR 81

Emergency Medicine Cases

MAY 24, 2022

In this first part of our 2-part series on Cardiac Arrest Controversies Rob Simard, Bourke Tillman, Sara Gray and Scott Weingart discuss with Anton how best to ensure high quality chest compressions, the pros and cons of mechanical CPR, the literature on dual sequential defibrillation and optimizing pad placement, epinephrine vs vasopressin, amiodarone (..)

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Defibrillator Epinephrine CPR EMS 130

EMDocs

JANUARY 8, 2024

Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. It is reasonable to administer epinephrine 1 mg every 3 to 5 minutes for cardiac arrest. High-dose epinephrine is not recommended for routine use in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R.

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Epinephrine Defibrillator Coronary CPR 81

The Skeptics' Guide to EM

DECEMBER 25, 2021

Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Bystander CPR is being performed. The monitor is hooked up. The paramedics performed high-quality CPR and follow their ACLS protocol. CPR is continued while a supraglottic airway is placed successfully.

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Epinephrine CPR Emergency Department ALS 130

ALiEM

MAY 29, 2023

Initial Management After a rapid assessment, we inserted an anterior nasal pack, soaked in epinephrine, TXA, and an antibiotic-based lubricant. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

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E-9-1-1 Epinephrine Emergency Department 246

The Skeptics' Guide to EM

MAY 8, 2021

SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone. I have not seen a validation study published.

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Epinephrine CPR EMS 130

The Skeptics' Guide to EM

DECEMBER 7, 2018

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. An oral airway is placed, peripheral intravenous (IV) line started successfully and the paramedic asks her partner if you want to administer IV epinephrine? He is unsuccessfully shocked.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

OCTOBER 22, 2022

This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. Background: We have covered Out of Hospital Cardiac Arrests (OHCAs) many, many times on the SGEM.

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CPR Defibrillator Epinephrine Firefighter 130

Pediatric EM Morsels

SEPTEMBER 22, 2023

Both norepinephrine and epinephrine can be used. Epinephrine is key if there is significant bradycardia. Crystalloid may help, but neurogenic shock may not respond to fluid administration. Alpha 1 agonists are necessary to maintain appropriate blood pressure.

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E-9-1-1 Epinephrine ALS OR 273

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Epinephrine is provided and you quickly place an advanced airway. A second dose of epinephrine is given, and you start to think about reversible causes and your next steps for in-hospital cardiac arrests (IHCA). Cardiopulmonary resuscitation (CPR) is in progress. The monitor shows a non-shockable rhythm.

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Epinephrine Critical Care Emergency Department Life Support 100

Emergency Medicine Cases

JANUARY 14, 2020

The post EM Quick Hits 12 AFib Early vs Delayed Cardioversion, Snake Bites, Ovarian Torsion Myths, Crystal Meth, Aortic Dissection, Severe Asthma Meds appeared first on Emergency Medicine Cases.

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Epinephrine EMS Emergency Management Emergency Manager 130

EMDocs

JANUARY 23, 2024

. #2: Treat bradycardia Calcium: 1 g calcium chloride or 3 g calcium gluconate IV; redosing is often necessary Epinephrine: 5-10 mcg/minute Will improve heart rate and shift potassium intracellularly If still unstable after calcium and epinephrine, pacing will be needed Skip atropine #3: Treat hyperkalemia If thinking BRASH, start hyperkalemia treatment (..)

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Epinephrine Overdose OR 86

EMS 12-Lead

MARCH 30, 2024

After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). Two paramedics are in the rear of the ambulance managing resuscitation (another crew had arrived and provided support with a driver). During transport, the paramedic not dedicated to compressions is able to establish IV access in the patient's hand.

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CPR Paramedic Ambulance Defibrillator 312

The Skeptics' Guide to EM

OCTOBER 31, 2020

Buffered lidocaine 1%, epinephrine 1:100,000 with sodium bicarbonate (hydrogencarbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. Epinephrine in Local Anesthetics: This will not make the tip of things fall off (nose, fingers, toes, etc). Reference: Vent et al.

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Epinephrine Emergency Department EMS ALS 130

The Skeptics' Guide to EM

JANUARY 13, 2024

We have looked at OHCA more than a dozen times on the SGEM.

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Defibrillator CPR First Responder Life Support 260

Handtevy

MAY 10, 2024

IM Epinephrine for Anaphylaxis : Correct dosing is common, with improved times to administration. Study Results Highlight: Midazolam for Seizure : Error-free dosing in the last quarter of 2023! Fentanyl for Pain : Marked decrease in dosing variability, although underdosing still occurs.

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EMS Emergency Medical Services Epinephrine ALS 52

Core EM

JANUARY 25, 2024

HIET improves contractility without increasing SVR, while vasopressin and epinephrine transiently increase SVR/MAP but worsen cardiac output in anesthetized dogs given propranolol (Holger 2007). Insulin versus vasopressin and epinephrine to treat β-blocker toxicity. Strong trend across different study designs for superiority of HIET.

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Overdose ALS Epinephrine Critical Care 188

REBEL EM

OCTOBER 11, 2023

” If the patient has compromise to airway, breathing or circulation, they should get immediate epinephrine. In anaphylaxis, think, “If A, B or C, give E.” D-dimer can effectively rule out a larger portion of low risk patients if age adjustment or the YEARS criteria are employed.

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Epinephrine EMS OR 80

Emergency Medicine Cases

OCTOBER 22, 2019

We discuss that the palpation technique is poor at determining whether or not a patient has a pulse, that the POCUS pulse is more accurate and as rapid compared to the palpation technique at determining whether or not a patient has a pulse, the difference between true PEA arrest, PseudoPEA and PREM, why epinephrine may be harmful in PEA, Weingart's (..)

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Epinephrine EMS OR 130

Dr. Smith's ECG Blog

MARCH 1, 2023

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms.

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Allergic Reaction E-9-1-1 Epinephrine Coronary 52

Don't Forget the Bubbles

DECEMBER 25, 2023

Disease-Oriented Outcomes (DOOs) The PARAMEDIC-2 trial looked at the effectiveness of epinephrine in adult patients who suffered an out-of-hospital cardiac arrest. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% A randomized trial of epinephrine in out-of-hospital cardiac arrest.

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Epinephrine ALS OR Paramedic 83

The Skeptics' Guide to EM

FEBRUARY 11, 2023

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), epinephrine ( SGEM#238 ) and IO vs IV (SGEM#231 and SGEM#340).

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Defibrillator Medical Transportation OR CPR 137

FOAMfrat

AUGUST 1, 2023

In this book, we're coving: Oxygen Albuterol and Atrovent Epinephrine Aspirin Nitroglycerin Naloxone Oral Glucose Gel and Glucagon + Flashcards in the back! We've also included medication profiles, tips and tricks from experienced providers, and flashcards for each medication to help you hone your med knowledge base!

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EMT EMT Naloxone Epinephrine 52

REBEL EM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration.

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ALS Epinephrine Critical Care Emergency Department 102

ALiEM

NOVEMBER 29, 2023

Xylazine is an alpha-2 agonist similar to clonidine that inhibits the release of norepinephrine and epinephrine resulting in decreased vascular tone and heart rate [4]. Xylazine use is also associated with severe necrotic skin ulcerations and superimposed infection [3, 4]. How does xylazine toxicity present?

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Naloxone Overdose ALS Epinephrine 169

The Skeptics' Guide to EM

FEBRUARY 25, 2023

1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. Today we are focusing on sodium bicarbonate.

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CPR ICU Critical Care Defibrillator 130

EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred. Epidemiology Most common cause: inadvertent intravascular injection. 5,8] In one review the incidence of LAST was estimated to be 2.7

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E-9-1-1 Plasma Epinephrine Life Support 92

Core EM

JANUARY 25, 2024

Removal: Lokelma (Sodium Zirconium cyclosilicate) Luckily residents have never had to use Kayexalate Can start working in 1-2 hours of administration 0.37

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Epinephrine OR ED 188

Peter Canning

JANUARY 14, 2024

The pediatric epinephrine and norepinephrine infusion rates have been lowered to 0.1-0.5 AEMTs may administer epinephrine IV in cardiac arrest.* .* Paramedics may administer buprenorphine to patient in precipitated withdrawal following naloxone resuscitation provided the patient meets required criteria and agrees to hospital transport.*

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CPR Naloxone Advanced Life Support EMT 52

REBEL EM

SEPTEMBER 1, 2022

Suspected hypocalcemia or hyperkalemia) Results: 391 patients analyzed Mean age 68 years 82% of cardiac arrests occurred at home 75% of cardiac arrests had non-shockable rhythms 60% of patients received trial drug through an IO of which 90% were tibial Survival at 1 Year: Calcium: 4.7% Placebo: 9.1% RR 0.51; 95% CI 0.24 Placebo: 8.6%

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Epinephrine Overdose ALS OR 52

Critical Care Scenarios

MAY 31, 2020

To hemodynamically manage RV failure without worsening RV afterload, consider the Rule of 8s cocktail:* Epinephrine.08 .* The flip side of hypoxic vasoconstriction is hyperoxic vasodilation of the pulmonary vasculature—i.e. an overly high FiO2 will tend to worsen V/Q matching.* 08 mcg/kg/min* Dopamine 8 mcg/kg/min* Vasopressin.08

Critical Care 100

Critical Care Epinephrine ED ALS 100

EM Literature of Note

OCTOBER 20, 2022

Thin Evidence Supporting Thrombolysis of Those on Blood Thinners Epinephrine Norepinephrine, That Is the Question Ill PREPAREd-II Intubate the Critically Ill Enjoy! How FAST Can You Spot a Pneumothorax?

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Epinephrine 40

The Skeptics' Guide to EM

FEBRUARY 20, 2021

Five Medical Myths in Emergency Medicine Myth #1: The use of non-selective NSAIDs will cause a nonunion in long bone fractures Myth #2: Topical anesthetics will cause blindness if used in simple corneal abrasions for less than 48 hours Myth #3: Mild paediatric gastroenteritis is best treated with expensive oral electrolyte solutions Myth #4: Tranexamic (..)

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