Trick of the Trade: Combine Adenosine with the Flush

2019 literature update from this original 2012 Trick of the Trade post!

The success of adenosine depends as much on the administration technique as it does the mechanism of action. The 2010 Advanced Cardiac Life Support (ACLS) Guidelines recommend the following when administering adenosine:

“6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push”

This recommendation remained in the 2015 iteration.

While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2024-06-18T22:34:55-07:00Oct 31, 2019|Cardiovascular, Tox & Medications, Tricks of the Trade|

The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years [1]. Globally, measles kills over a hundred thousand children [2]. In the U.S., one child dies for about every 1,000 cases [3]. Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).

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By Carolina Ornelas|2019-10-31T12:57:05-07:00Oct 28, 2019|Dermatology, Infectious Disease, Pediatrics|

In pediatrics, the history and physical examination is paramount. But even the most seasoned professional can have a challenge when facing a wiley 2-year-old. What strategies can you use to get in, get out, get the information you need, and maybe even make a (very small) friend in the meantime?

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By Aditi Mitra, MD|2019-10-31T13:02:31-07:00Oct 23, 2019|Pediatrics|

SAEM Clinical Image Series: Eye Trauma and Vision Loss

The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported.

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By Cassandra Mackey, MD|2019-11-10T21:42:57-08:00Oct 21, 2019|Ophthalmology, SAEM Clinical Images, Trauma|

SplintER Series: A Toddler’s Missed Step

A mother and father bring their 2-year-old boy to the Emergency Department after the child tripped over the family dog while running across the living room after a ball. He will not walk and points at his right lower leg and says it hurts (photo credit).

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By Matthew Negaard, MD|2019-10-30T20:58:49-07:00Oct 16, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Chief complaint: Double vision

History of Present Illness: 61 year old female with history of HTN, DM, hyperlipidemia, and chronic low back pain presenting with double vision. She received an epidural spinal injection yesterday for the 4th time for low back pain. She was sedated for the procedure and woke up with headache, neck stiffness, and left eye “jumping around,” which progressed to double vision 1 hour later.

There was no blurry or double vision with either eye closed. She had 1 episode of emesis. She presented to the ED 24 hours later with continued headache and double vision.

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By Richard Wang, MD|2019-10-30T21:13:07-07:00Oct 14, 2019|Neurology, Ophthalmology, SAEM Clinical Images|

SAEM Clinical Image Series: Bumps and Balls

A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia.

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By Anwar Ferdinand, MD|2019-11-10T21:41:57-08:00Oct 14, 2019|Dermatology, Infectious Disease, SAEM Clinical Images|