EMCrit Podcast Network

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Canal • 3 programas

Medicina

Medicina

Cada dos semanas
Superación personal

Superación personal

Cada dos semanas
Medicina

Medicina

Cada mes

26 jul

EMCrit 430 - Members Q&A Episode 004

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8 may

EMCrit Wee - 2026 PE Update F/u with Josh Farkas & Justin Morgenstern

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29 mar

EMCrit 422 - SSC 2026 Guidelines: The good, the Bad, and the UGLY

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11 jul

EMCrit 429 - RUSH 2.0 - The I-RUSH and CRUSH Exams

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2 jun

EMCrit Wee - Dr. Glacoumflecken on the Amazing Eugene EM Physicians Triumph over Corporate Medicine

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17 jun

EMCrit Wee - Phil and Rory on the 4 Interface Model for Shock Physiology

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17 abr

EMCrit 423 - Hyperbaric Therapy for Carbon Monoxide Poisoning?

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9 abr

EMCrit Wee - You Don't Understand Dizziness and Vertigo - But You Need To!!!

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10/07/2009

EMCrit Podcast 6 – Push-Dose Pressors

Note: Please listen to the PDP update episode either before or immediately after listening to this one Finally a non-intubation topic! Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation. They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed. Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulse Has alpha and beta-1/2 effects so it is an inopressor Onset-1 minute Duration-5-10 minutes Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml) Now you have 10 mls of Epinephrine 10 mcg/ml Dose: 0.5-2 ml every 1-5 minutes (5-20 mcg) No extravasation worries! Mixing Video: Phenylephrine Phenyl as a bolus dose is clean, quick, and never causes trouble. But... It is pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output. I only use this in tachycardic patients (and even then, only sometimes) Onset-1 minute Duration- 5-10 minutes (usually 5) Mixing Instructions: Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml) Inject this into a 100 ml bag of NS Now you have 100 mls of phenylephrine 100 mcg/ml Draw up some into a syringe; each ml in the syringe is 100 mcg Dose: 0.5-2 ml every 1-5 minutes (50-200 mcg) No extravasation worries! Mixing Video: Ephedrine I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog. Onset-Near Instant Duration-1 hour Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml) Now you have 10 mls of Ephedrine 5 mg/ml Dose: 1-2 ml every 2-5 minutes (5-10 mg) No extravasation worries! Additional Video of a Real Patient By Larry Mellick's Crew Update: This study compares push-dose phenylephrine to continuous infusion--no difference between the two (Anesthesia Analgesia 21012;115(6):1343) First article in the ED demonstrates efficacy on blood pressure (The Journal of Emergency Medicine Volume 49, Issue 4, October 2015, Pages 488–494) Here is a review article from the nursing literature Now on to the Podcast...
17/05/2015

Podcast 149 – Thyroid Storm

When hyperthyroidism goes really wrong...

EMCrit Podcast and Friends!