Does adrenaline need a central line?

iv-adrenalineIt has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this. Diluted solutions of epinephrine and norephrine are safe for infusion via a well funcioning 18-20G IV proximal to the wrist.



Sweet Paraphimosis

paraphimosisTrick of the Trade

Sugar solution for non-reducible paraphimosis

  1. Mix 50 mL of 50% dextrose solution with 2% lidocaine jelly.
  2. Place a gauze into the solution.
  3. Place soaked gauze on the glans of penis.
  4. Cover with condom or condom foley.
  5. Wait 1 hour.
  6. Reduce the paraphimosis.

The high solute concentration of the sugar water pulls the water from the swollen tissue while lidocaine provides topical analgesia to allow the reduction of the retracted foreskin back over the glans of the penis.


STEMI Equivalents

  • Isolated Posterior Myocardial Infarction.
  • Isolated ST-Depression in AVL
  • Hyperacute T-waves (HATWs)
  • De Winter Pattern
  • ST Elevation (STE) in AVR
  • Presumed New Left Bundle Branch Block