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Anti-NMDA Receptor Encephalitis in Children and Adolescents

Pediatric EM Morsels

Treat the seizures , but…. Keep in mind that seizure management can be difficult and the patient may not respond to AEDs. 2014 Feb;13(2):167-77. 2014 Feb;13(2):135. May see non-specific white and gray matter changes. Moral of the Morsel It’s NOT always psych! Earlier diagnosis leads to better outcomes. 2019.12.016.

Seizures 269
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Super Refractory Status Epilepticus

Don't Forget the Bubbles

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?

Seizures 111
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Fluoroquinolone Use In Children

Pediatric EM Morsels

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Fluoroquinolone Use in Children: Indications for use Let’s keep this simple, Pseudomonas ! The low dose range (30 mg/kg) did show sporadic lesions.

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emDOCs Revamp: Alcohol Withdrawal

EMDocs

2014; 28(5): 401-410. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Muncie H, Yasinian Y, Oge L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician.

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EM@3AM: Amniotic Fluid Embolism

EMDocs

Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here. Epub 2014 Jun 30. If AFE occurs during labor, immediate delivery is recommended. PMID: 24974876.

EMS 96
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TXA in head injuries

Don't Forget the Bubbles

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. There was a small increased risk of seizures in the TXA group – 0.3% (7 children) of the 1900 children in the TXA group vs none of the 1900 children in the non-TXA group. 2014 Dec;77(6):852-8; discussion 858. J Trauma Acute Care Surg.

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ToxCard: N-Acetylcysteine for Acetaminophen Toxicity

EMDocs

2014 Sep-Oct;52(8):856-67. Epub 2014 Aug 18. Massive acetylcysteine overdose associated with cerebral edema and seizures. Clin Toxicol (Phila). 2015;53(10):941-949. doi:10.3109/15563650.2015.1100305 Gosselin S, Juurlink DN, Kielstein JT, Ghannoum M, Lavergne V, Nolin TD, Hoffman RS; Extrip Workgroup. Clin Toxicol (Phila).