In part 1 of the cardiac arrest series, we review some key recommendations and clinical pearls from the 2020 adult BLS and ACLS guidelines.

References:

Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468

Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circulation. 2020; 141 (25): e933- 943

Velissaris D, Karamouzos V, Pierrakos C, et al. Use of sodium bicarbonate in cardiac arrest: current guidelines and literature review. J Clin Med Res. 2016; 8 (4): 277-283

Murchison C. Sodium bicarbonate therapy does not work in cardiac arrest. Updated November 5, 2018. Accessed December 1, 2020. http://www.emdocs.net/sodium-bicarbonate-therapy-does-not-work-in-cardiac-arrest/

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

What is dual/double defibrillation? How does it work? Does it improve patient outcomes? Find out this week!

References:

Miraglia D, Miguel LA, Alonso W. Double defibrillation for refractory in- and out-of-hospital cardiac arrest: a systematic review and meta-analysis. J Emerg Med. 2020; 59 (4): 531-541

Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

What happens when/ if etomidate goes on shortage? Are methohexital or ketamine viable options for RSI in the ER? Find out this week.

References:

Farrell NM, Killius K, Kue R, et al. A comparison of etomidate, ketamine, and methohexital in emergency department rapid sequence intubation. J Emerg Med. 2020; 59(4): 508-514

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

In this episode, we discuss the pros and cons of the main antiplatelet agents used in the setting of ACS. Who comes out on top?

References:

Norgard NB, DiNicolantonio JJ. Clopidogrel, prasugrel, or ticagrelor? A practical guide to use of antiplatelet agents in patients with acute coronary syndromes. Postgrad Med. 2013; 125(4): 91-102

Thachil J. Antiplatelet therapy- a summary for the general physicians. Clin Med. 2016; 16(2): 152-160

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

The rate of IV magnesium administration depends on the particular indication, dose, and patient-specific factors. Tune in for more details.

References:

Kaye P, O’Sullivan I. The role of magnesium in the emergency department. Emerg Med J. 2002; 19: 288-291

Grissinger M. Avoiding patient harm from a magnesium bolus dose. P & T. 2014; 39(2): 81-82

Preventing magnesium toxicity in obstetrics. ISMP. Updated October 5, 2005. Accessed November 2 2020. https://www.ismp.org/resources/preventing-magnesium-toxicity-obstetrics

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

Days away from Halloween, we discuss a few common ER superstitions. Are they actually legit? Or do you belive the data? Your call.

References:

Brookfield CR, Phillips PPJ, Shorten RJ. Q fever- the superstition of avoiding the word “quiet” as a coping mechanism: randomized controlled non-inferiority trial. BMJ. 2019; 367: 16446

Lamb JN, Howard AJ, Marciniak J. Does the word ‘quiet’ really make things busier? RCS Bull. 2017; 99: 133-136

Exadaktylos AK, Sclabas G, Siegenthaler A, et al. Friday the 13th and full-moon: the "worst case scenario" or only superstition? Am J Emerg Med. 2001; 19(4): 319-20

Zargar M, Khaji A, Kaviani A, et al. The full moon and admission to emergency rooms. Indian J Med Sci. 2004; 58(5): 191-195

Walling HW. Actual versus perceived workload for house officers: black cloud looming? Ann Intern Med. 2004; 140 (10): 847-848

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

Bradycardic? Hypotensive? Keep the agent discussed in this week's episode in mind when reviewing your patient's medication list.

References:

Rains J, Kesterson J. Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female. Am J Emerg Med. 2020; Article in Press

Abbas SA, Hamadani SM, Ahmad U, et al. Ophthalmic timolol and hospitalization for symptomatic bradycardia and syncope: a case series. Cureus. 2020; 12(3): e7270

Wang Z, Denys I, Chen F, et al. Complete atrioventricular block due to timolol eye drops: a case report and literature review. BMC Pharmacology and Toxicology. 2019; 20: 73

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

In Part 2 of this "Mini Grand Rounds" series, we discuss important side effects of ATII including thrombosis, especially in the setting of COVID.

References:

Celi A, Cianchetti S, Dell’Omo G, Pedrinelli R. Angiotensin II, tissue factor and the thrombotic paradox of hypertension. Expert Review Cardiovasc Therapy. 2010. 8 (12)

Senchenkova EY, Russell J, Almeida-Paula LD, et al. Angiotensin II-mediated microvascular thrombosis. Hypertension. 2010; 56 (6): 1089-1095

Zhang P, Zhu L, Cai J, et al. Association of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res. 2020: 126 (12): 1671-1681

Tralhao A, Moita LF, Povoa P. Potential benefits of angiotensin II in COVID-19 patients: beyond reasonable doubt? Crit Care. 2020; 243 (324)

Zangrillo A, Landoni G, Beretta L, et al. Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series. Crit Care. 2020; 24: 227

Want H, Das S, Wieruszewski PM, et al. Unexpected BP sensitivity to angiotensin II in a patient with coronavirus disease 19, ARDS, and septic shock. CHEST. 2020; 158 (2): e55-58

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

In Part 1 of this "Mini Grand Rounds" series, we discuss Angiotensin II use for vasodilatory shock, reviewing the ATHOS-3 trial and real-world experiences.

References:

Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. NEJM. 2017; 377: 419-430

Farina N, Bixby A, Alaniz C. Angiotensin II brings more questions than answers. P T. 2019; 43 (11): 685- 687

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

Should we be giving procainamide to patients with atrial fibrillation/ flutter? We discuss two clinical trials that may give us some answers.

References:

Stiell IG, Clement CM, Symington C, et al. Emergency department use of intravenous procainamide for patients with acute atrial fibrillation or flutter. Acad Emerg Med. 2007; 14: 1158-1164

Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomized trial. Lancet. 2020; 395 (10221): 339-349

Disclaimer: 
The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician,  and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.

Support the show

Find ER-Rx:

- On Instagram: @ERRxPodcast
- On the website: errxpodcast.com
- On YouTube

Disclaimer:

The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.