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Written by: Dean Hayes (NUEM 27) Edited by: Andrew Long (NUEM 25 ) Expert Commentary by: Rafael Lima, MD A mid 20s male presents to the ED after seizure-like activity. Per the patient's partner at bedside, he had a 2-3 minute convulsive episode and the description is consistent with a likely seizure. and Can Kratom cause seizures?
Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Consider intubation for patients with airway compromise, respiratory failure, altered mental status, or seizure. 5 Seizure: IV benzodiazepine first line, barbiturates as second line.
A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Despite this, the CFAM still showed ongoing electrical seizure activity.
Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management. What causes Super Refractory Status Epilepticus?
3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 In one study, almost all patients who went on to develop seizures had tachycardia prior to the seizure.
However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. 2011 Sep;15(2):211-40. This includes intraparenchymal hemorrhage and subarachnoid hemorrhage (SAH). N Engl J Med.
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.
Goldfrank’s Toxicologic Emergencies, 9e New York, NY: McGraw-Hill; 2011. MetHb < 25% with symptoms Abnormal vital signs Metabolic acidosis End organ dysfunction (i.e. Methemoglobin Inducers. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. Link Post Peer Reviewed By: Salim R.
This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.
All went well. HELLP Syndrome [pdf] Sara Paul MD Intrauterine Fetal Demise [ppt] Irene Hwang, MD Obesity in Pregnancy [pdf] Rafael Garabis, MD Seizures in Pregnancy [ppt] Sherifia Heron , MD Substance Abuse in Pregnancy [ppt] Sophia Y. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Episiotomy [ppt] Alice Teich, MD.
Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.
Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.
meningitis), intractable seizures, low GCS, increased risk of aspiration or airway obstruction such as pathological obstruction (e.g. The reason this doesn’t work well when there is an air leak is because the expired tidal volume detected by the flow sensor is inaccurate. This means that SIMV does not work as well as AC with VG.
All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records. This includes subdural hematomas, comas, paraplegia, quadriplegia, fractures and seizure disorders, regardless of the time interval between the injury and death.
ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. Microb Drug Resist 2011; 17:267. In: PostTW, ed.
for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%
haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 2x maintenance rate
(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.
Moreover, it does not follow a coronary distribution very well. The QTc looks prolonged ( well over half the R-R interval ) although accurate QTc assessment becomes challenging at this rapid a rate. By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL.
The CSF studies return positive for CSF VDRL as well as for CSFfluorescent treponemal antibody-absorption test (FTA-ABS), with 75 WBCs/microL and a CSF protein of 60 mg/dL and elevated opening pressures. 2011 Jul;33(5):433-60. Cerebrospinal fluid (CSF) studies are obtained in the recumbent position for opening pressures.
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