Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR

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. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care.

E-9-1-1

REBEL EM

NOVEMBER 6, 2023

to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) Until further evidence presents itself, what this study offers is building upon what we do know.

ICU

Dr. Smith's ECG Blog

JANUARY 19, 2025

Escalating vasopressor support: On epinephrine 0.6 Continued discussion with the ICU as well as with CV surgery. On arrival to the ICU, was noted to be in atrial fibrillation but with controlled ventricular response, and lower heart rate than one would expect with this degree of hemodynamic instability as well as pressor requirements.

MICU

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction

Dr. Smith's ECG Blog

FEBRUARY 17, 2022

In addition, intermittent profound hypotension and bradycardia occurred compromising RCA flow responsive to epinephrine boluses. Ultimately, epinephrine infusion, norepinephrine and dopamine infusion as well as RV pacing was necessary to maintain an adequate blood pressure and coronary perfusion.

Epinephrine

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). Disposition to ICU. Insulin versus vasopressin and epinephrine to treat β-blocker toxicity. J Med Toxicol. 2020;16(2):212-221.

Overdose

REBEL EM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 It also reduced length of stay in ICU and hospital without adverse effects. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

ICU

EMDocs

OCTOBER 19, 2024

2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8] However, these patients often present with drooling and a preference for the tripod position, which is uncommon in bacterial tracheitis. [2][3]

EMS

EMDocs

DECEMBER 18, 2023

34 If a MAP of 65 mmHg is still not achieved, epinephrine should be added as a third agent (Figure 1). For patients with septic shock and cardiac dysfunction that are persistently hypotensive, it is appropriate to use norepinephrine and dobutamine or epinephrine alone. 32,33 Once the dose of norepinephrine is between 0.25-0.5

E-9-1-1

REBEL EM

SEPTEMBER 26, 2022

The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease. were performed.

FFP

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU.

Defibrillator

ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 Most agents exhibit both vasopressor and inotropic effects (Figure 1). mg/kg) IM: (1:1000): 0.1

E-9-1-1

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. They achieved ROSC and wanted to transfer to our institution for post-arrest care. After ROSC achieved: Sinus rhythm.

Epinephrine

Dr. Smith's ECG Blog

APRIL 6, 2018

Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. No other cause of arrest was identified based on lab results or pan-CT scan.

Defibrillator

AAEM RSA

AUGUST 27, 2020

The 48-hour group had a significantly longer length of stay in the ICU and time on mechanical ventilation amongst survivors, both of which were expected since they were kept at target temperature for longer, requiring more resources. Time to TTM was statistically significantly shorter in the IC group (2.2

E-9-1-1

ACEP Now

NOVEMBER 14, 2023

If it is determined that the bleeding originates from one lung it is recommended to position the patient in lateral decubitus with the bleeding lung down to avoid contamination of the contralateral lung. Portable chest X-ray may help determine from which lung the bleeding originates. 13,14 The typical regimen is 500 mg three times daily.

E-9-1-1

EMDocs

OCTOBER 29, 2024

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. Curr Opin Crit Care. 2016;22(3):260-266.

E-9-1-1

EMDocs

MAY 6, 2025

Left ventricular outflow tract obstruction in ICU patients. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. m/s)problematic and elevated > 50 mm Hg (4.5 Curr Opin Crit Care. 2016;22(3):260-266. doi:10.1097/MCC.0000000000000304 0000000000000304 Alrammah H, Ghazal S. Clin Cardiol.

E-9-1-1

EMDocs

JANUARY 14, 2025

Have push dose epinephrine at the bedside as induction can remove sympathetic tone and result in a vagal episode. Anyone with progressive symptoms or more findings on exam than paresthesias alone should be admitted to the hospital, likely to an ICU setting, due to the risk of decompensation. Normally, you should be able to get to 20.

Plasma

FOAMfrat

DECEMBER 4, 2024

LVEDP (measured in the ICU using a Swan-Ganz or pulmonary artery catheter) is the pressure inside the left ventricle at the end of diastole, when the LV is at its fullest. Low-dose epinephrine is a strong beta-1 drug with minimal alpha-1 effects if you stay below ~0.08 Aortic diastolic blood pressure is easy enough. mcg/kg/min.

Coronary

Dr. Smith's ECG Blog

APRIL 18, 2025

The patient was transferred to the ICU on pressors, where a repeat bedside echo showed an LVEF of 10-15%. He suffered another cardiac arrest in the ICU with ROSC after another dose of epinephrine and one round of CPR.

ED