It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this.
The ability of ketamine to produce dissociation is of great value to clinicians who perform painful procedures in general emergency medicine
The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29). There was no benefit to patients not requiring oxygenation support and even a signal for harm. It is important to remember this is a preprint, preliminary report, which is better than a press release. At this time, in patients requiring any oxygen therapy, HFNC, NIV, IMV, or ECMO I would recommend dexamethasone until further evidence disproves this benefit.
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.
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 of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios (95% credible intervals) were 1.24 (0.91 to 1.82) for celecoxib, 1.48 (1.00 to 2.26) for ibuprofen, 1.50 (1.06 to 2.04) for diclofenac, 1.53 (1.07 to 2.33) for naproxen, and 1.58 (1.07 to 2.17) for rofecoxib. Greater risk of myocardial infarction was documented for the higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations.
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 | May cause hypotension |
Paralytics
| Medication | Weight-Based Dosing | Time to Onset of Action | Adverse Effects/
Contraindications |
| Succinylcholine | 1.5 – 2.0 mg/kg | 45-60 seconds | Bradycardia. Malignant hyperthermia. Hyperkalemia. |
| Rocuronium | 1.2 mg/kg | 45-60 seconds | |
| Vecuronium | 0.1 mg/kg | 2-4 minutes | Questionable RSI utility when rocuronium available |
Post-Intubation Sedation
| Medication | Weight-Based Dosing | Notes |
| Midazolam | 0.04-0.2 mg/kg/hr | Short duration, but with long-term use has long half-life. Often used with fentanyl |
| Propofol | 5-80 mcg/kg/min | Propofol Infusion Syndrome with long term use: monitor TG, amylase/lipase |
| Dexmedetomidine | 0.2-0.7 mcg/kg/hr | |
| Ketamine | 0.5-1 mg/kg/hr | May decrease bronchospasm |
| Fentanyl | 1-2 mcg/kg bolus25-250 mcg/hr | |
