Why fentanyl is better than morphine

If you had a Mount Rushmore of Emergency Department drugs fentanyl would make a pretty solid case for its inclusion. This synthetic opioid is roughly 100x more potent than morphine. The onset is rapid – two to three minutes. This is in contrast to morphine, which can take up to 20 minutes. The duration of action is relatively short – 30 to 60 minutes. Again, for purpose of comparison, the duration of action of morphine is up to 4 hours. As opposed to other opioids (namely morphine) there is no histamine release.

Good chest compressions during CPR does lead to significant injuries.

A brief accounting of the injuries from CPR from this study show:

  • Multiple rib fractures: 57.3%
  • Sternal fractures: 54.2%
  • Intrathoracic bleeding: 36.1%
  • Cardiac injuries: 7.2%
  • Liver injuries: 3.6%

Luckily none of these injuries were judged to have contributed to the cause of death.

The Death of Cricoid Pressure (CP) during intubation (and other stories)

Bottom Line: In spite of over 50 years of application, there is minimal evidence to either the pathophysiologic basis or clinical utility of CP. CP also appears to decrease the likelihood for 1st pass success. CP should not be performed routinely. External laryngeal manipulation, either by the operator or an assistant, may improve an otherwise suboptimal laryngeal view.

Understanding intubation and ventilation…the Pearls and Pitfalls

A normal minute ventilation involves a minute ventilation between 5 and 8 L [ie, 500–600 mL, rate 10–14 breaths/minute]. In severely ill COPD and asthma patients, overventilation risks auto-PEEP and barotrauma; a starting rate of six breaths with a 500 mL volume allows maximum time for exhalation.

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Please DO NOT give Sodium Bicarbonate – IT’S HARMFUL TO YOUR ACIDOTIC PATIENT – TREAT THE CAUSE

Sodium bicarbonate may increase serum pH, but may worsen rather than improve prognosis.  Other than indications where sodium bicarbonate is the treatment for the acidosis (such as TCA overdose), the treatment for metabolic acidosis is to correct the underlying cause, whatever it may be.

AHA 2015 Guidelines: A Preview

On October 15, the new American Heart Association Guidelines for CPR and ECG will be published. Then we will get the answers to the big questions many of us have wondered about?

  1. Has epinephrine in cardiac arrest seen its last days?
  2. Should paramedics continue to intubate cardiac arrest patients?
  3. Will traditional CPR be abandoned for cardiocerebral Resuscitation (CCR)?