Thread by @TILEDPharmD

This weekend I learned what an intra-cardiac epinephrine is. Wish I could say it was from a 📔 or topic discussion... 😂 Nope, it was John Doe, 🎁 w/ cc of traumatic arrest s/p lots and lots of 🔪 wounds 🙃... so what is intra-cardiac EPI❔❔❔

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#MedTwitter #TwitteRx

Just as it sounds 🤦‍♂️... EPI 💘 directly into the myocardium. Generally only used in ATLS after performing an ED thoracotomy in conjunction w/ manual cardiac compression

So here are a few clinical pearls I learned from John Doe

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💎
[Dosing & Freq] = same as ACLS ➡️ 1 mg Q 3-5min.
✅ There are pre-filled 💉 products specific for intra-cardiac use, but ISMP says ⛔️ d/t risk for errors.

Also, there isn't great evidence on what volume to use... what does ur institution use?

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💎💎 The key differences are in the 💉 length & gauge
✅ Consider 21- or 22-gauge needle
✅ Length 1.5" closer to 3.5"... really, whichever you can 🏃‍♂️💨💨 faster

💎💎💎 Administer via rapid push directly into the L ventricle
✅ Cardiac massage should be ongoing!

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💎💎💎💎 Complications include:
Coronary artery laceration, cardiac tamponade, pneumothorax, and can interrupt external chest compression/ventilation

Bottom Line ⏩ Same dose, different needle...& make sure ur 🔗 to the internet in the trauma bay 😭

PMID: [16759407][10978796]