The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. It was a witnessed clonic-tonic seizure that stopped but he did not wake up.

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Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

Cook County EM Blog

MAY 29, 2023

Signs and symptoms of toxicity include alerted mental status, seizures, CNS depression, apnea, respiratory failure, hypotension, ventricular dysrhythmias, and cardiac arrest. If a therapeutic dose is chewed, it can lead to bronchospasm, laryngospasm, seizures, and cardiovascular collapse which further reinforces the danger to children.

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Seizures Administration Resuscitation Poisoning 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

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Sepsis Shock Resuscitation Fluid Resuscitation 78

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] 2017, July 10). What are the symptoms of cyanide poisoning? Goldfrank’s Toxicologic Emergencies, 11e.

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Poisoning Pediatrics Seizures Administration 67

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. 2017 Sep 12 [cited 2023 Nov 30];archdischild-2016-311377. What is atypical HUS?

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Dehydration Infectious Diseases Seizures Pediatrics 59

Dr. Smith's ECG Blog

JANUARY 21, 2023

The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. CMAJ 2017 Vassallo SU, Delaney KA, Hoffman RS, et al. Seizure activity was witnessed in the ED. Is this takotsubo? J wave syndromes.

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Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Advanced Emergency Nursing from AENJ

MAY 14, 2017

" Some epileptic seizures will be heralded by a loud inspiratory "cri du epilepsie" as the diaphragm contracts in spasm and by the strong negative pressure against a partially closed larynx (in the form of a Müller maneuver or "reverse Valsalva maneuver") similar to that made by a partially-obstructing laryngospasm.

Dislocations 40

Dislocations Emergency Nursing Seizures Fractures 40

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. However, cardiac syncope is always a differential diagnosis when someone presents with first time seizures. There are a number of things to look for in an ECG that can hint at arrhythmia as the cause of an apparent seizure.

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Seizures EKG/ECG EMS Stroke 115

Downeast Emergency Medicine

APRIL 26, 2021

We know that if administered too rapidly, it can lead to hypotension and other adverse effects including seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired color vision, and other visual disturbances.[1] Lastly, the use of TXA is not without risk.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

Other considerations in significant TBI would be the temporary use of anti-epileptic drugs as prophylaxis to prevent early post-traumatic seizures to aid neuroprotection; the most commonly used would be levetiracetam. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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. This guideline was condensed and summarised; Tate et al, Archives of Disease in Childhood Education and Practice 2017.

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EKG/ECG Hospitals Shock Documentation/Coding 98

ACEP Now

APRIL 2, 2024

8 Seizures and thunderclap headache from reversible cerebral vasoconstriction syndrome have been reported. 2018:bcr-2017- 224085. 6 Inadvertent exposure to the eyes can result in severe pain, lacrimation, visual blurring, conjunctival injection, lid swelling; corneal injuries are possible. to recall the product. BMJ Case Rep.

Burns 40

Burns Poisoning Seizures Stroke 40

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. 2017; 15:47-50. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric EM Morsels

OCTOBER 6, 2023

Let us take a moment to review Typhoid Fever in children : Typhoid Fever: Basics Salmonella enterica serotype Typhi is the causative bacteria and represents 75% of cases of enteric fever (GBD 2017) Salmonella enterica serotypes Paratyphi A, B and C cause Paratyphoid fever which has clinically indistinguishable features.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

PEMBlog

MAY 9, 2024

Febrile Seizures are among the most common neurological problema in young children, occurring in 1 out of 50 children between the ages of 6 months and 5 years of age. Febrile Seizure. Common variants associated with general and MMR vaccine-related febrile seizures. 2017 Jul;70(1):52-62.e6. Epub 2017 Mar 2.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

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

EMDocs

APRIL 10, 2024

She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. 1,5] CNS symptoms include: Seizure, coma, altered mental status. [1] 2,9] Benzodiazepines are the first line treatment for seizures. How do we manage patients in LAST? mL/kg/min. [2]

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Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 105

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.

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Seizures EKG/ECG Poisoning Shock 77

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. Neurocrit Care.

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Seizures Stroke Outcomes EMS 95

Don't Forget the Bubbles

JULY 5, 2023

Do not use pethidine since it can cause seizures and CNS hyperexcitability. Pediatr Allergy, Immunol Pulmonol 2017; 30: 191–201. Alternatives to morphine are hydromorphone or fentanyl. They should be used for patients who cannot tolerate morphine side effects (extreme pruritus or nausea). Anemia ; 2015.DOI:10.1155/2015/791498.

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Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. 2017 Dec;10(1):1. Epub 2017 Jan 25. 2017, 43:226-8. Minimal histamine release. Cons: Short duration of action. Pain upon injection. Adrenal suppression, limiting its use in long procedures or critically ill patients. Excellent amnestic and sedative properties. Can be titrated easily.

Emergency Department 76

Emergency Department Soft Tissue Injuries Airway Management Operations 76

EMDocs

OCTOBER 5, 2024

4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017. Imipenem confers highest risk of seizures ESBL-E are often hospital acquired infections and can prolong hospital stay or lead to worse outcomes. 2017 Jun 28;12(6):e doi: 10.1371/journal.pone.0180121. N Engl J Med.

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EMS Infectious Diseases Sepsis Hospitals 86

Taming the SRU

APRIL 17, 2023

Severe cases may result in seizures or coma. 2017 Sep-Dec;21(3):101-104. 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. J Am Acad Dermatol. 1990;23(5 Pt 1):829.

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Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Pediatric Education

SEPTEMBER 1, 2024

Complications include death, scarring, skin superinfection, sepsis, encephalitis, meningitis, febrile seizures, and premature birth. It was considered extinct but in 2017 it was reconstituted in the laboratory causing controversary because of its similarity to smallpox. Patients are not contagious after the crusts fall off.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Sepsis 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

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. link] Chava, R.,

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Hyperthermia / Hypothermia EMS Stroke Seizures 80

EMDocs

MARCH 11, 2024

Among children, hypoglycemia is common and can lead to seizures. Cholera vaccines: WHO position paper – August 2017. Published online August 25, 2017. The incubation period is very short (12 hours to 5 days), which allows the number of cases in the area to rise extremely quickly. Front Cell Infect Microbiol. 2020;10:582554.

Dehydration 102

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 102

Pediatric EM Morsels

NOVEMBER 15, 2024

Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! We have even talked about using a ketogenic diet to control seizures , and seizure mimics.

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Seizures Stroke Pediatrics Wellness 152

EMDocs

NOVEMBER 4, 2024

million patient complaints in 2017, making it the second most common ED complaint. National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017 Emergency Department Summary Tables (2017). doi:10.1136/emermed-2017-206944 Mokhtari A, Yip O, Alain J, Berthelot S. 2017 Apr 4;166(7):514-530. Epub 2017 Feb 14.

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Emergency Department Fractures Burns EMS 105

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Patients with trauma, alcohol, or drug-associated loss of consciousness and definite seizures were excluded. Thiruganasambandamoorthy, V., Sivilotti, M., Mukarram, M., Baumann, B.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 13, 2023

Semin Ultrasound CT MR 2017, 38 (4), 345-356. J Neurointerv Surg 2017, 9 (2), 122-126. Laryngoscope 2017, 127 (1), 79-86. J Neurol Neurosurg Psychiatry 2017, 88 (1), 45-53. Intensive Care Med 2017, 43 (6), 785-794. CTA head/neck is absolutely indicated if suspicion is high for this condition. 4) Madhuripan, N.;

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Stroke Radiology Radiology Emergency Department 98

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

In my experience CNS catastrophes ( not only SAH or other CNS bleeds but brain tumor trauma seizures coma from other cause ) may cause some of the most bizarre-appearing ECGs. Smith Cardiac cath was negative and today's unfortunate patient succumbed from her devastating SAH ( S ub A rachnoid H emorrhage ).

EKG/ECG 86

EKG/ECG Resuscitation EMS Seizures 86

Taming the SRU

FEBRUARY 3, 2025

These can lead to a wide spectrum of emergent complications including but not limited to cardiac dysrhythmias, seizures, and acute renal failure. This can often become significant enough to precipitate dysrhythmias, seizures, and tetany (20). 2017-0278-RS 3. 2017-0147 4. doi:10.1155/2017/9684909 6. Oncologist.

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Fluid Resuscitation Seizures Dehydration Emergency Department 55

EMDocs

JANUARY 6, 2025

She presents with a seven-day history of fever, fatigue, and myalgias associated with decreased oral intake and an episode of seizure-like activity three hours prior to arrival. Additionally, there is no family history of seizure disorders. A review of systems is notable for nausea and vomiting but no diarrhea. doi:10.1136/bmj.327.7426.1271

Infectious Diseases 67

Infectious Diseases CDC PPE Rapid Diagnostic Testing 67

Don't Forget the Bubbles

OCTOBER 9, 2023

A 13-year-old girl came to the ED with an unprecedented, prolonged seizure. When she arrived in the department, the seizure had stopped. Personal experience How often have you been a victim of incivility or, indeed, the perpetrator? A head CT scan was arranged. How did it make you feel? Have you been uncivilised to a work colleague?

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Seizures Incident Reporting Research Emergency Department 116

Taming the SRU

JANUARY 5, 2025

Potential complications include dysrhythmias, respiratory failure, DIC, seizures, and hepatic failure. 2017 Feb;37(1):67-71. mg/kg initially followed by 1mg/kg q6hrs Disposition NMS can be very severe and usually requires ICU level care. Workup for complications should be initiated on a case by case basis. J Clin Psychopharmacol.

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Hyperthermia / Hypothermia Dehydration Psychiatric Poisoning 97