Don't Forget the Bubbles

AUGUST 12, 2024

Do we need seizure prophylaxis? Children and young people have lower seizure thresholds than adults. Following TBI, seizures are common and may be missed in children and young people who are sedated and paralysed. Either levetiracetam or phenytoin can be used for seizure prophylaxis. Published 2016 Feb 4.

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Seizures Pediatrics Emergency Department Ambulance Services 75

Don't Forget the Bubbles

MARCH 18, 2024

A similar process can also occur in the CNS (causing seizures ), the liver and the pancreas. Depending on the progression of the illness, children may present with pallor, oedema, lethargy, seizures, hypertension or abnormal liver function tests. 2016 Oct 10 [cited 2023 Nov 30];281(2):123–48. 2016 Jan;6(1):e009933.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

EMDocs

JANUARY 17, 2024

Neurologic symptoms: Encephalopathy, seizures, or coma (5,7) Cardiovascular symptoms: Hypotension, conduction disturbances, ventricular tachycardia or fibrillation, pulseless electrical activity, or asystole (10) Breaking, crushing, or chewing the capsules can produce numbness, choking, bronchospasm or laryngospasm. (5) PubMed PMID: 34219543.

Poisoning 67

Poisoning Seizures Pediatrics EMS 67

EMDocs

DECEMBER 6, 2024

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.

Poisoning 75

Poisoning Fluid Resuscitation Seizures Resuscitation 75

The Skeptics' Guide to EM

DECEMBER 7, 2019

The change in name took place in 2016. The subcommittee on ALTEs in the AAP published a practice guideline renaming ALTEs to brief resolved unexplained events ( BRUEs ) in 2016. If even the folks who are really expert in the topic are not applying the definition consistently, then perhaps it’s time for a new definition.

Pediatrics 52

Pediatrics Seizures CPR Hospitals 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. Look for old ECGs Do serial ECGs Do echocardiography June 17, 2016 Anterior STEMI? The diagnostic problem posed in today's repost from June 17, 2016 is a perfect example of this. The patient is a 36yo man who was seen for a seizure.

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EKG/ECG Seizures EMS Outcomes 52

ALiEM

NOVEMBER 15, 2023

1,6,7] Dizziness, confusion, headache Shortness of breath Weakness and malaise Nausea and vomiting Hypotension, seizures, coma, apnea, arrhythmias Death due to cardiorespiratory arrest How do you diagnose cyanide poisoning? [7] 6.2017JADWEB-2016-0075. What are the symptoms of cyanide poisoning? Journal of Acute Disease. BMJ Case Rep.

Poisoning 67

Poisoning Pediatrics Seizures Administration 67

EMDocs

AUGUST 22, 2023

Published 2016 Jan 29. In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause. PMID: 24381677 Bou Chebl R, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC Emerg Med. Eur Respir J. 2010;35(4):735-741.

Emergency Department 67

Emergency Department Blood Transfusions Resuscitation Sepsis 67

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. The diagnostic problem posed in today's repost from June 17, 2016 is a perfect example of this. The patient is a 36yo man who was seen for a seizure. I'm highlighting it again, with comments from Ken Grauer below. There was no chest pain.

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EKG/ECG Seizures EMS Outcomes 52

PEMBlog

MARCH 27, 2024

2016 Jan;37(1):3-15; quiz 16-7, 47. They include neurologic dysfunction, which is one of the most common that includes things like developmental delay, regression, AKA loss of developmental milestones, hypotonia, encephalopathy, or seizures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Pediatr Rev.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Northwestern EM Blog

MARCH 28, 2022

Clinical Findings of Methanol Poisoning CNS sedation Seizures Rapid, Deep Breathing Hypotension Ocular findings: Blindness Afferent pupillary defect Optic disk hyperemia Mydriasis Ethylene Glycol Toxicity Similarly, the toxic metabolites of ethylene glycol cause end-organ damage at levels greater than 20mg/dl. Br J Clin Pharmacol, 2016.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Don't Forget the Bubbles

JULY 26, 2023

Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. In 2016 the American Academy of Paediatrics issued a clinical guideline on brief unresolved unexplained events (BRUEs) which had previously been known as ALTEs.

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EKG/ECG Hospitals Shock Documentation/Coding 98

Pediatric Emergency Playbook

JUNE 1, 2017

The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI. 2016; 203:138-140. 2016; 10(6):14-15. 2016; 17:2. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. International Journal of Cardiology.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

Meanwhile, the patient has just returned from a scan and had a seizure in front of you because his brain is speckled with contrast; post-ictus, he's apneic despite airway measures, and now one must give mouth-to-mouth because there's no bag at the bedside … see what I mean? Disposable BVMs (one at every bedside).

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Pediatric Emergency Playbook

APRIL 1, 2016

S – seizure or shock – most commonly septic, but can be any type: cardiogenic, bstructive, hypovolemic, distributive. 2016; 417: 54–56. Difficult to interpret lactates when a patient is on an epinephrine drip. 2012; 33:1040–1045. Koerbin G, Potter JM, Abhayaratna WP et al. Clinica Chimica Acta. Am J Cardiol. 2012;110:284 –289.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric EM Morsels

AUGUST 18, 2023

Jackson 2016) Ciprofloxacin was the first fluoroquinolone approved by the FDA in the 1980’s as a broad-spectrum antibiotic. Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. Arthropathy was seen in 13.7%

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Pediatrics Infectious Diseases Seizures Hospitals 130

Don't Forget the Bubbles

JANUARY 24, 2024

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

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Pediatric EM Morsels

OCTOBER 6, 2023

Mogsale 2016, Shah 2021)Stool cultures are only positive in 30% of cases if collected in 2 nd -3 rd week of illness which makes them a poor choice for definitive diagnosis. 2016; 15: 32. Due to low sensitivities and cross-reactivity in those who are vaccinated, blood cultures are the preferred method to diagnosis.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 6 Seizures have been observed and are dose-dependent. 1 Benzodiazepines are preferred as the first line of treatment for agitation or seizures. 2016 Dec;54(10):899-923. 1,2,6 Neurologic effects: Sedation is a primary concern with overdose. Clin Toxicol (Phila).

Poisoning 89

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 89

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent.

Seizures 65

Seizures EKG/ECG Poisoning Shock 65

The Skeptics' Guide to EM

SEPTEMBER 7, 2019

She is also the […] The post SGEM#265: Total EcLiPSE of the Seizure – What a ConSEPT first appeared on The Skeptics Guide to Emergency Medicine. Case: Julia is a 4-year-old girl with a history of seizures and developmental delay. Our focus on management of status is to stop the seizures quickly to avoid any complications. . *

Seizures 52

Seizures Emergency Department Hospitals 52

EMDocs

AUGUST 3, 2023

2016 Jul;54(6):519-22. Epub 2016 Apr 27. Massive acetylcysteine overdose associated with cerebral edema and seizures. PMID: 25133498 Ghannoum M, Kazim S, Grunbaum AM, Villeneuve E, Gosselin S. Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics. Clin Toxicol (Phila).

Poisoning 80

Poisoning Seizures Administration Pediatrics 80

Taming the SRU

NOVEMBER 13, 2024

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

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Psychiatric Seizures Emergency Department Pediatrics 88

EMDocs

JULY 3, 2023

4 Common symptoms of SAH on presentation include vomiting, neck stiffness, altered mental status or decreased level of consciousness, hemiparesis, and seizure-like activity. 18 Seizure Seizure is common in the setting of acute SAH, especially spontaneous SAH, due to cerebral and meningeal irritation. 2016 Aug;25(1):29-39.

Seizures 84

Seizures Stroke Outcomes EMS 84

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. .; 2016 Sep 15;375(11):1033-43. Epub 2016 Jun 8. N Engl J Med.

Stroke 72

Stroke Outcomes EMS Seizures 72

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

This includes subdural hematomas, comas, paraplegia, quadriplegia, fractures and seizure disorders, regardless of the time interval between the injury and death. Accessed 07/30/2016. Accessed 07/30/2016. Accessed 07/30/2016. Accessed 07/25/2016. April 6, 2016. Accessed 07/25/2016. Accessed 07/25/2016.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. 2016 Sep;117 Suppl 1:i9-i13. Minimal histamine release. Cons: Short duration of action. Pain upon injection. Adrenal suppression, limiting its use in long procedures or critically ill patients. Propofol: Mechanism of Action: GABA A Pros: Rapid onset and offset of action. Can be titrated easily.

Emergency Department 65

Emergency Department Soft Tissue Injuries Airway Management Operations 65

Taming the SRU

APRIL 17, 2023

Severe cases may result in seizures or coma. McGraw Hill; 2016. These atropine-like alkaloids produce an anticholinergic syndrome when smoked or ingested. Patients typically present with tachycardia, mydriasis hyperthermia, altered mental status, anhidrosis, and urinary retention. Poisonous Plants. Accessed March 19, 2023.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Don't Forget the Bubbles

JULY 10, 2023

Seizures may also occur, as may paralysis. Global epidemiology of vaccine-derived poliovirus 2016–2021: A descriptive analysis and retrospective case-control study. Paralytic polio is not only more common in older patients but also more severe. Quadriplegia is more common in adults. Encephalitis is rare. Lancet ID 2022; 22(10):1412-14.

Seizures 75

Seizures Operations Pediatrics Hospitals 75

Pediatric Emergency Playbook

SEPTEMBER 1, 2016

Headache plus… a new seizure. An eleven-year-old girl presents to the ED with new headache, nausea, and vomting in the morning, then had a generalized seizure later that day, and presents with a low GCS. 2016 Jul;32(7):435-9. 2016 Apr 19;4:CD005220. Headache plus… it’s unilateral and new for the patient. J Neurosurg.

Pediatrics 52

Pediatrics Seizures Emergency Department Wellness 52

Pediatric Education

JUNE 25, 2023

Borate toxicity can cause abdominal pain, diarrhea, emesis, fever, irritability, seizures, and death. Toxic borate exposure can occur through inhalation, or oral and dermal routes with non-intact skin being a bigger problem. Borates can cause skin irritation and there can be some reproductive changes as well.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Outcomes 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

2016) in the presence of spontaneous BrS ECG or drug-induced ECG. Heart Rhythm 2016. There are limited data regarding the impact of EP study in BrS patients triggered by fever. An EP study might be helpful in symptomatic patients (Sroubek et al., The prognostic significance of fever-induced Brugada syndrome.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

AUGUST 1, 2018

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. 2015;313(24):2456-2473. Subst Abus.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

DECEMBER 16, 2023

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Clinical decision making in seizures and status epilepticus. The patient is agitated, not oriented, and becoming combative with ED staff. A 12-lead EKG shows sinus tachycardia but is otherwise normal. 1 Fever is usually < 40C. Updated 2022 Oct 24].

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

EB Medicine

FEBRUARY 1, 2019

In addition, one 2016 study demonstrated a LR of 0.01 Seizures are very common as well. That’s quite a list. For a visual reference, see Table 3 in the print issue. Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EMDocs

NOVEMBER 4, 2024

Headache red-flag characteristics include neurological symptoms, thunderclap nature, syncope, trauma, immunocompromised, coagulopathy, fever, rash, seizure, nuchal rigidity, altered mental status, pregnancy, temporal tenderness, jaw claudication, and cancer history. doi:10.1136/tsaco-2016-000064 Zink KA, Mayberry JC, Peck EG, Schreiber MA.

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Emergency Department Fractures Burns EMS 97