Tag Archives: emcrit

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!

Submassive PE on EMCrit

Back in RAGE Session Two we discussed ‘Thrombolysis for Submassive Pulmonary Embolus’. This was actually just before the PEITHO trial was published, though we were able to anticipate many of the findings thanks to the wonders of the web.

A great follow up to our discussion is EMCrit Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman. This discussion reiterates many of the conclusions the RAGE team came to, with additional discussions about catheter-directed thrombolysis and reduced dose thrombolysis.

Meanwhile, the NEJM has just published correspondence in response to the PEITHO trial -it  includes a comment about half-dose thrombolysis by Rory Spiegel, myself and Ryan Radecki.

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!