Category Archives: RAGEback

RAGEback: Swami on Adrenaline in Cardiac Arrest

Anand ‘Swami’ Swaminathan is an Emergency Physician in New York. He is one of the co-creators of EM Lyceum, and a major contributor to Lifeinthefastlane.com, primarily through R&R in the Fastlane and The LITFL Review, as well as other FOAM resources.

Swami is a skeptic of the benefit of adrenaline in cardiac arrest. This is his brief response to Scott Weingart’s Cutting Edge Intra-Arrest Care at smaccGOLD and Weingart’s subsequent discussion about intra-arrest meds with Rob Mac Sweeney on EMCrit.

For a summary of the articles discussed check out Swami’s ‘Epinephrine in Cardiac Arrest‘ post on emdocs.net, which includes links to all of the relevant studies. Scott Weingart also has another relevant discussion in EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest.

Thanks again for listening to the RAGE!

RAGEback: Weingart and co on Asthma

This RAGEback includes commentary and reaction to the RAGE Session Three discussion of severe life-threatening acute asthma. It features comments from Mary Shue on THAM, Greg Miller on lignocaine and someone called Scott Weingart (anyone heard of him?) on non-invasive ventilation.

Here’s some stuff on lignocaine (a fairly evidence free zone!):

  • BestBets: Lignocaine as a pretreatment to Rapid Sequence Induction of patients with Status Asthmaticus 
  • Maslow AD, Regan MM, Israel E, Darvish A, Mehrez M, Boughton R, Loring SH. Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma. Anesthesiology. 2000 Nov;93(5):1198-204. PubMed PMID: 11046206. [Free Full Text]
  • More recently though, this paper suggested some beneficial effects on bronchoconstriction post-intubation:
    Adamzik M, Groeben H, Farahani R, Lehmann N, Peters J. Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma. Anesth Analg. 2007 Jan;104(1):168-72. PubMed PMID: 17179265.

Some stuff by Scott Weingart on Emcrit.org relevant to this discussion:

Finally, some useful links from the LITFL Critical Care Compendium:

Thanks again for listening to the RAGE!

RAGEback: Minh Le Cong, Verapamil and SVT

The discussion of verapamil as an option for the treatment of supraventricular tachycardia (SVT) in RAGE Session Two went off like a fire cracker in the FOAM world.

In this RAGEback, Minh Le Cong from the PHARM podcast explains why the RAGE discussion is not going to change his practice, which is to use adenosine as a first line agent.

This is followed by a response by RAGErs Karel and Cliff.

You — the listener — are left to make up your own mind about which patients (if any) you’ll consider verapamil as an option.

References and Links

Minh cites these references (in the order they were mentioned):

  • Leitner RP, Hawker RE, Celermajer JM. Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. Aust Paediatr J. 1983 Mar;19(1):40-4. PubMed PMID: 6870700.
  • Delaney B, Loy J, Kelly AM. The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis. Eur J Emerg Med. 2011 Jun;18(3):148-52. doi: 10.1097/MEJ.0b013e3283400ba2. Review. PubMed PMID: 20926952.
  • Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J. 1992 Jun;123(6):1543-9. PubMed PMID: 1595533.
  • Anugwom C, Sulangi S, Dachs R. Adenosine vs. calcium channel blockers for supraventricular tachycardia. Am Fam Physician. 2007 Jun 1;75(11):1653-4. Review. PubMed PMID: 17575655. [Free Full Text]
  • Brady WJ Jr, DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil. Acad Emerg Med. 1996 Jun;3(6):574-85. PubMed PMID: 8727628.

Karel and Cliff added these to the mix:

  • Holdgate A, Foo A. WITHDRAWN: Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005154. doi: 10.1002/14651858.CD005154.pub3. Review. PubMed PMID: 22336809. [Free Full Text] (note: withdrawn by the author due to lack of time and resources to update)
  • Miyagawa K, Dohi Y, Ogihara M, Sato K. Administration of intravenous calcium before verapamil to prevent hypotension in elderly patients with paroxysmal supraventricular tachycardia. J Cardiovasc Pharmacol. 1993 Aug;22(2):273-9. PubMed PMID: 7692169.
  • Riaz R, Mishra J, Hussain S, Sinha LM. Adenosine Versus Verapamil for the Treatment of Supra-ventricular Tachycardia: Randomized Comparative Trial. Pakistan J Med & Health Sci. 2012 Jul-Sept [Free Full Text]
  • Lapage MJ, Bradley DJ, Dick M 2nd. Verapamil in infants: an exaggerated fear? Pediatr Cardiol. 2013 Oct;34(7):1532-4. doi: 10.1007/s00246-013-0739-8. Epub 2013 Jun 26. PubMed PMID: 23800976.

Roie Tal’s Prezi journal club presentation on the Lapage et al 2013 article:

The links mentioned at the end are:

Thanks again for listening to the RAGE! 

RAGEback: Andy, Amit and the ETM Twitter Fiasco

As promised in RAGE Session Two, Andy Buck and Amit Maini from the Emergency Trauma Management (ETM) course are here to give their side of the story of what happened when a slide from their course was tweeted out of context leading to an unexpected backlash.

Be sure to check out:

Thanks again for listening to the RAGE!