EM Quick Hits 13 – One Syringe Adenosine, Pertussis Pearls, Hyperemesis Gravidarum, Tramadol, Hypertension Myths, KOBI

Brought to you byTopics in this EM Quick Hits podcast Salim Rezaie on single syringe adenosine for SVT (0:30) Sarah Reid on pertussis pearls (05:00) Elisha Targonsky on management of hyperemesis gravidarum (11:23) Joe Nemeth on the utility of hypertension as a risk factor in EM (19:05) Justin Morgenstern on tramadol myths (25:50) Reuben Strayer on ketamine only breathing intubation (KOBI) (31:12) Podcast production, editing and sound design by Anton Helman with additional editing by Sheza Qayyam Written summary & blog post by Sucheta Sinha edited by Anton Helman Cite this podcast as: Helman, A. Rezaie, S. Reid, S. Targonsky, E. Nemeth, J. Morgenstern, J. Strayer, R. EM Quick Hits 13 - One Syringe Adenosine, Pertussis Pearls, Hyperemesis Gravidarum, Tramadol, KOBI, Hypertension Myths. Emergency Medicine Cases. February, 2019. https://emergencymedicinecases.com/em-quick-hits-february-2020/. Accessed [date]. Single syringe adenosine for SVT * Adenosine is recommended in the 2015 American Heart Association ACLS guidelines for stable regular narrow-complex supraventricular tachycardia * Adenosine has a rapid onset and a half life of <10 seconds, hence needs to be administered rapidly * It has traditionally been administered with a 2 way stop cock and tandem saline flush * A recent single center prospective observational non-inferiority study of 53 patients with SVT compared single syringe adenosine diluted with normal saline compared to the double syringe technique and found that 73.1% vs 40.7% converted to sinus rhythm respectively; with 3 doses of single syringe adenosine, there was a 100% conversion to normal sinus rhythm compared to only 70% in double syringe * Our expert's approach to stable SVT is to first try the modified valsalva maneuver followed by diltiazem 0.25 mg/kg IV over 2 min q15 mins x2 prn before moving to single syringe adenosine Expand to view reference list * Lim SH, Anantharaman V, Teo WS, Chan YH. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation. 2009;80(5):523-8. * Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. * Mcdowell M, Mokszycki R, Greenberg A, Hormese M, Lomotan N, Lyons N. Single-syringe Administration of Diluted Adenosine. Acad Emerg Med. 2020;27(1):61-63. * Salim Rezaie, "Single Syringe Adenosine for SVT?", REBEL EM blog, December 12, 2019. Available at: https://rebelem.com/single-syringe-adenosine-for-svt/. Pertussis: when to consider it, how to diagnose it, and how to treat it * Pertussis is a contagious bacterial respiratory infection traditionally seen in non vaccinated children; however vaccination does not provide full immunity and there is waning im...