Community first responders for out-of-hospital cardiac arrest in adults and children.

CONCLUSIONS: Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted.The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured.We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types. PMID: 31323120 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research

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Opioids can bind to brain receptors that are responsible for breathing, causing hypoventilation, and all too frequently leading to death in those that overdose. Naloxone (aka Narcan) is an antidote that prevents opioids from binding to brain receptor...
Source: Medgadget - Category: Medical Devices Authors: Tags: Emergency Medicine Source Type: blogs
We report a case of a 12-year-old boy presenting with a long-lasting skin rash and dyspnea who was incorrectly diagnosed with early anaphylactic shock and was treated with 10-fold the recommended dose administered by the wrong route (intravenous instead of intramuscular). He reacted with acute loss of consciousness and acute cardiorespiratory failure due to arterial hypotension, ischemic heart failure, and severe pulmonary edema. He responded rapidly to mechanical ventilation, treatment with diuretics, and low-dose inotropes and recovered without sequelae. Despite this ultimately favorable outcome, we report this case to r...
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
CONCLUSION: Despite implementation of a PDR, dosing errors, including ten-fold errors, still occur at a high rate. Errors occur with dilution and length-based tape use. Further error reduction strategies, beyond a PDR and that target errors of omission, are needed for pediatric prehospital drug administration. PMID: 31084508 [PubMed - as supplied by publisher]
Source: Prehospital Emergency Care - Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research
This case report describes changes in the electrocardiogram of a patient with anaphylaxis after an overdose of epinephrine.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
‚ÄčThe atomizer is a handy tool to instill life-saving medication into the nose, and you should consider stocking them if you don't already. An atomizer can be used to administer naloxone and countless other drugs as well as for moderate sedation and pain control. Pediatric and adult patients alike can benefit from intranasal fentanyl or Versed. Studies on intranasal epinephrine for anaphylaxis also look promising, but it does require a higher dose—5 mg instead of 0.3 mg. (Asian Pac J Allergy Immunol 2016;34[1]:38; http://bit.ly/2Prpjhb.)The atomizer is easy to use and can be attached to any syringe. Each spray creat...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Management of acetaminophen toxicity typically involves administering N-acetylcysteine (NAC) in order to prevent hepatic injury. While NAC is considered the gold standard of therapy, it is also associated with risk of non-immunologic anaphylaxis. This case illustrates a less commonly recognized reaction to NAC and provides an opportunity to review management of acetaminophen toxicity in patients who demonstrate such a reaction.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: M057 Source Type: research
Abstract Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltrans...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
This article was commented on at REBEL EM: http://rebelem.com/the-role-of-tee-in-cardiac-arrest/
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This article was commented on at REBEL EM: http://rebelem.com/the-role-of-tee-in-cardiac-arrest/
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract Evidence-based review of the existing literature ultimately recommends stocking of methylene blue (MB) as an emergency antidote in the United States. The same is reported around the world in Japan, Greece, Italy and Canada. The observation that MB is always present as the main antidote required in emergency and critical care units calls for a revisit on its effects on the NO/cGMP system to reemphasize its multisystem actions. Therefore, the present review aimed to display the role of MB in emergency units, concerning: 1) Polytrauma and circulatory shock; 2) Neuroprotection, 3) Anaphylaxis and, 4) Overdose...
Source: Current Drug Targets - Category: Drugs & Pharmacology Authors: Tags: Curr Drug Targets Source Type: research
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