Start Peripheral Vasopressors Early in Shock!

It 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 all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) . No old IVs (>72 hrs) Know how […]

Giving adenosine for SVT

Giving adenosine 6mg in 20mL of saline as a single syringe push vs the usual 6mg push and rapid flush with 20mL saline is non-inferior for the treatment of SVT.

NSAIDS increase risk of Heart Attacks

A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days, the probability of increased myocardial infarction risk (posterior probability […]

Local Anaesthesia Toxicity (LAST)

The key in managing LAST is prevention. Know your dose, know your maximum dose, always aspirate prior to injection and ask patient about symptoms Lidocaine toxicity cardiovascular complications are typically preceded by neurological signs/symptoms. If these develop, stop administration, place patient on monitor and ready your antidote Bupivacaine toxicity can be sudden and catastrophic. If […]

Rapid Sequence Intubation Medications

Induction Agents Medication Weight-Based Dosing Time to Onset of Action Adverse Effects/ Contraindications Etomidate 0.3 mg/kg <1 minute May cause clinically insignificant adrenal suppression. Ketamine 1-2 mg/kg 1-3 minutes May increase blood pressure. May cause hypersalivation. Propofol 2 mg/kg <1 minute May cause hypotension. Cardiac depressant. Contraindicated in egg/soybean allergy Midazolam 0.3 mg/kg 1-5 minutes […]

Emergency Medicine Kenya Foundation

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