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Grand Rounds Recap 5.22.24

Taming the SRU

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. Benefits of transport are evidenced based.

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Pediatric Status Epilepticus

Pediatric Emergency Playbook

Definition of status epilepticus:Continuous seizure activity of 5 minutes or greater – OR – Recurrent activity without recovery between intervals. This definition includes clinically apparent seizures as well as those seen only on EEG.) During a seizure, GABA receptors in the neuron’s membrane are internalized and destroyed.

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MI in Children

Pediatric Emergency Playbook

The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI. 2009; 8:67-69. 2009; 24:156-8. 2009; 27:942-947. 2009; 27:942-947. 2004; 90:e17. Canale LS et al. Güvenç O et al.

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Big Labs, Little People

Pediatric Emergency Playbook

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. S – seizure or shock – most commonly septic, but can be any type: cardiogenic, bstructive, hypovolemic, distributive. 2009; (55) 12:2098–2112. Don't go looking, if you won't do anything with the test. 2014;30: 493-495.

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EM@3AM: Hyperthermia

EMDocs

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients Arch Intern Med 2009 Jul 27; 169:1299-1305. Arch Intern Med 2009 Jul 27; 169:1262. Sivilotti, M.,

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CT Angiography Head and Neck: Indications and Limitations

EMDocs

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

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