Since before any of us did a manual defibrillation, cracked any ribs while

doing compressions, or drilled that first I.O., epinephrine had been used

by all of those medics that have come before us on countless cardiac

arrests. Epinephrine has been around forever as is practically ubiquitous

for the treatment of cardiac arrest.  The question is should it be? The

P.A.R.A.M.E.D.I.C.-2 trial was just published in the New England Journal of

Medicine this week and it is further confirming the suspicions of many that

the “Amp of Epi” for every adult arrest is potentially more harmful than

helpful. Take a listen and decide for yourself.

https://www.nejm.org/doi/full/10.1056/NEJMoa1806842

References:

A Myth Revisited: Epinephrine for Cardiac Arrest. (2017, May 23). Retrieved

July 21, 2018, from

http://www.emdocs.net/myth-revisited-epinephrine-cardiac-arrest/

Morgenstern, J. (2018, July 21). Paramedic 2: Epinephrine harms/helps in

out of hospital cardiac arrest. Retrieved July 21, 2018, from

https://first10em.com/paramedic2/#more-6140

Perkins, G. D., Ji, C., Deakin, C. D., Quinn, T., Nolan, J. P., Scomparin,

C., . . . Lall, R. (2018). A Randomized Trial of Epinephrine in

Out-of-Hospital Cardiac Arrest. New England Journal of Medicine.

doi:10.1056/nejmoa1806842

Spiegel, R. (2018, July 20). EM Nerd-The Case of the Costly Compound.

Retrieved July 21, 2018, from

https://emcrit.org/emnerd/em-nerd-the-case-of-the-costly-compound/

OK everybody I screwed up, this weeks episode was mean’t to be the first

attempt at a “Vid-cast” but we hit a glitch that would not allow the video

to be sent to iTunes for download. So with my sincere apologies I am going

to release this episode as an audio podcast instead and I will just link to

the intended video instead. I don’t think you lose a ton by not seeing the

video as long as you are familiar with the equipment I am talking about,

but for those truly visual learners I am very sorry.

https://vimeo.com/278968710 Here is the link to the original “Vid-Cast” of

this episode

Capnography for endotracheal tube placement is considered standard of care

by most experts, but the use of non-invasive capnography is widely

dependent from region, service, and even individual providers preference.

This episode reviews the indications for using capnography by non-invasive

means, and ways to use things in your ambulance to make you own sampling

devices so you can provide the highest level of care even when your service

won’t provide you with the optimal supplies.

Tubing the critically ill patient is usually a team sport to some extent, but what would you do if the only ones in the room were you and the patient. Learn about a piece of equipment and technique that could save you and your patient when you gotta do that tube solo.

When your patients pressure is in the toilet fluid resuscitation can only take you so far in certain clinical scenarios, and occasionally a vasoactive agent must used to keep them out of the morgue. NYC paramedics are getting a new vasopressor added to their tool box for treating the critically ill. In this episode we will briefly review Norepinephrine, and make comparisons to Dopamine ( previously the only approved vasopressor infusion in the NYC region). Additionally, the protocols that Norepinephrine will appear in will be reviewed along with any possible safety concerns associated with its use. Lastly, the logistics of actually setting up the drip with use of a dial-a-flow will be covered. Whether you’re a NYC Medic who is getting Norepinephrine on the truck soon or you’ve already had it in your system this should be a nice review of a potentially life saving pressor.

We all intubate. Tubing the cardiac arrest is usually not as anxiety provoking as the patient that still has pulses, but regardless of the reason you have chosen to intubate it is often the initial confirmation strategy for determining that tubes placement that can be potentially harmful and even deadly to the patient you have just taken heroic measures on to save their life. If it is your common practice to initially confirm your tube's placement with your stethoscope or perhaps a colorimetric end-tidal device then take a listen to this episode and learn why that may be hurting your patients.

Hi, I'm Kevin and I'm a paramedic. Come listen to a short intro that explains who I am and whats this show all about. Enjoy!