Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. Meesters 2018) Resistance is growing (likely from inappropriate / overuse)!

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. As may be seen in the table below, there are several themes as well a range of stringency. Find the posterior superior iliac crest and draw an imaginary line across the back (Tuffier’s line) – where this line crosses midline is the L4 spinous process.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

EMDocs

DECEMBER 19, 2023

link] Published December 30, 2018. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Goldfrank’s Toxicologic Emergencies, 11e. McGraw Hill; 2019.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

EMDocs

AUGUST 28, 2023

A month later the child returns with seizures and altered mental status. Magana J, Medscape eMedicine, updated Jul 24, 2018. The following morning the film is over-read, and a possible femur fracture is reported. The ED is notified that further imaging is recommended, but the family is not informed so it is never done.

Fractures 82

Fractures Seizures Patient Safety Hospitals 82

ALiEM

OCTOBER 4, 2023

1, 5] Muscarinic symptoms (Common acronyms SLUDGE or DUMBBELLS) Salivation, emesis, diarrhea, and lacrimation Miosis Seizures Bradycardia, bronchospasm, and bronchorrhea are usually the cause of death. Use benzodiazepines such as diazepam or midazolam for seizures. 2018 Jan 5;359(6371):23. Provide supportive care. 359.6371.23.

Poisoning 78

Poisoning Seizures Hospitals 78

ALiEM

DECEMBER 4, 2023

2018 May 9;13:158-163. doi: 10.1515/med-2018-0025. Yang TY, Wang TY, Chen M, Sun FJ, Chiu AW, Chen YH. Penile Calciphylaxis in a Patient with End-stage Renal Disease: A Case Report and Review of the Literature. Open Med (Wars). PMID: 29756051; PMCID: PMC5941707.

Academics 60

Academics Seizures Hospitals Emergency Department 60

ALiEM

JUNE 1, 2023

NMDA Receptors: Role in Ethanol Withdrawal Seizures. Therapeutic Drug Monitoring of Antiepileptic Drugs in Epilepsy: A 2018 Update. The American Journal of Emergency Medicine. 2011;29(4):382-385. doi:10.1016/j.ajem.2009.10.010. 2009.10.010. PMID: 20825805 Hoffman PL, Grant KA, Snell LD, Reinlib L, Iorio K, Tabakoff B. doi:10.1111/j.1749-6632.1992.tb25955.x.

Emergency Department 98

Emergency Department Administration Seizures Hospitals 98

Taming the SRU

FEBRUARY 5, 2024

Admission should also be strongly considered in patients with a depressed GCS, post-traumatic seizure(s), or intractable symptoms [2]. This is a huge area for improvement nationally, as was demonstrated by a 2018 study that revealed that only 42% of patients seen at 11 US Level 1 trauma centers received educational materials on discharge [4].

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

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

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. 2018 [cited 2023 Dec 3]. What is atypical HUS? Though uncommon, HUS can be deadly.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Broome Docs

OCTOBER 31, 2022

Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. 2018 Sep 11;362:k3843. Lancet Neurol. 2022 Sep;21(9):781-791. doi: 10.1016/S1474-4422(22)00235-6. Lancet Neurol.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

Mind The Bleep

SEPTEMBER 12, 2023

Severe jaundice causing kernicterus may also cause central hypotonia and seizures. Everything Else Examine the abdomen for any organomegaly which can occur in metabolic or storage disorders or SCORTCH infections Look for signs of jaundice which can occur with hypothyroidism or inborn errors or metabolism.

Sepsis 52

Sepsis Seizures Poisoning Wellness 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. The majority of the inherited rhythm disorders are autosomal dominant but their diagnosis relies on an electrically active heart.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. Neurosurgery takes the patient to surgery after the CT angiogram suggests aneurysmal rupture.

Stroke 91

Stroke Outcomes EMS Seizures 91

Dr. Smith's ECG Blog

JANUARY 15, 2024

The most likely causes of artifact include inconsistent skin-electrode contact and body movement ( scratching, tremor, shivering, coughing, hiccups, brushing teeth, writhing in bed, seizure activity, interference from a mechanical device, etc. ). The January 30, 2018 post — for PTA. The August 26, 2019 post — baseline artifact.

EKG/ECG 65

EKG/ECG Point-of-Care Testing Wellness Shock 65

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

Dr. Smith's ECG Blog

OCTOBER 6, 2018

The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. My Comment by K EN G RAUER, MD ( 10/6 /2018 ): = Superb case presented by Dr. Meyers! I limit my comments to reinforcing several important concepts emphasized by him.

EKG/ECG 40

EKG/ECG Seizures Documentation/Coding Outcomes 40

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. 2018 Mar 5;6:17.

Seizures 98

Seizures Stroke Outcomes EMS 98

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Nachi: To attain the most up to date information for this article, Dr. Williams searched the PubMed and Cochrane Databases from 1950 to 2018. Jeff: Let’s get started with the pathophysiology.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Don't Forget the Bubbles

MAY 15, 2023

Signs and symptoms in this group are often non-specific and can include irritability, hypotonia, lethargy, jitteriness, temperature instability, poor feeding, vomiting, apnoea and seizures. Donaldson MDC, Gregory JW, Vliet VG, Wolfsdorf JI. Practical endocrinology and diabetes in children. Hoboken: Wiley-Blackwell; 2019.

Wellness 103

Wellness Seizures Hospitals Dehydration 103

Downeast Emergency Medicine

MARCH 24, 2021

Incubation typically 2-5 days, with illness lasting up to 10 days Association with Guillain-Barre syndrome Shigella Raw and unwashed vegetables Most common to get passed around daycare Seizures, AMS, coma Rectal prolapse possible from excessive diarrhea Fecal shedding E. Pediatr Emerg Med Pract 2018, 15(2):1-25. Sudbury, Mass.:

Pediatrics 52

Pediatrics Dehydration Emergency Department Wellness 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Heart Rhythm 2018. The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y y (3 of 88, 43.6 ± 37.4 Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome. In 588 patients with known Brugada syndrome and first arrhythmic event, 35 were during fever.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EMDocs

JUNE 7, 2023

7 Check out ToxCard: Nerve Agents by Dr. Sahi & Dr. Santos from July 2018 Organophosphates exert their toxic effects by inhibiting acetylcholinesterase within the synaptic cleft, which leads to accumulation of acetylcholine, with subsequent overstimulation of postsynaptic nicotinic and muscarinic receptors, and a predominant cholinergic effect.

Poisoning 97

Poisoning Airway Management Seizures PPE 97

Pediatric EM Morsels

OCTOBER 6, 2023

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.

Pediatrics 164

Pediatrics CDC Seizures Documentation/Coding 164

EMDocs

NOVEMBER 13, 2023

Stroke 2018, 49 (10), 2323-2329. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. .; Stroke 2018, 49 (3), e46-e99. Spine (Phila Pa 1976) 2018, 43 (9), E520-e524. Rijntjes, M.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

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. 2018 Nov;19(6):952-960. Epub 2018 Sep 10. West J Emerg Med.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

JULY 19, 2023

Further, organic mercury readily crosses the placenta where it acts as a teratogen leading to a wide range of birth defects including developmental delay, blindness, seizures, and limb malformation. 2018, February 1). Symptoms include tremor, personality changes , emotional lability, gait disturbance , paresthesias, and ataxia.

Poisoning 84

Poisoning Fluid Resuscitation Administration Seizures 84

Don't Forget the Bubbles

FEBRUARY 24, 2025

Infants usually present in a non-specific manner, following an apnoea, cough, cyanosis, or seizure so a high index of suspicion is required in this age group. The Pediatric Infectious Disease Journal 37(3):p 202-205, March 2018. Paediatric Critical Care Medicine 19(3):p 254-261 March 2018 Long et al. Pediatrics. Nieves et al.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

EMDocs

JANUARY 22, 2025

These included seizures, delirium, ARDS, hypotension, hypertension, and aspiration. drug seizure data, 2011-2016. Epub 2018 Dec 28. 2018 Aug 7;169(3):137-145. Epub 2018 Jun 19. The median IV dose administered was 0.2mg, and the median IM dose was 0.2 Published 2023 Sep 1. Drug Alcohol Depend. 2021;218:108416.

Seizures 91

Seizures Administration Emergency Department Poisoning 91

Don't Forget the Bubbles

JULY 5, 2023

Do not use pethidine since it can cause seizures and CNS hyperexcitability. J Hematol 2018; 93: 363-370 Rubin LG, Schaffner W. Alternatives to morphine are hydromorphone or fentanyl. They should be used for patients who cannot tolerate morphine side effects (extreme pruritus or nausea). Macharia AW et al. Care of the Asplenic Patient.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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. 2018 Nov;142(5):e20181009. Epub 2018 Oct 8.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

Pediatric Education

NOVEMBER 10, 2024

doi:10.1136/archdischild-2018-316603 Moodley A, Payton KSE. The classic triad of congenital toxoplasmosis is chorioretinitis (bilateral), intracranial calcifications and hydrocephalus. Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy. Arch Dis Child Educ Pract Ed. 2020;105(5):262-269.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Resuscitation 40

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. 2018) What’s in an eye roll? 2018) Bad manners in the Emergency Department: Incivility among doctors PLOS ONE [link] Lasater K, Mood L, Buchwach D. A head CT scan was arranged.

Seizures 116

Seizures Incident Reporting Research Emergency Department 116

EMDocs

MARCH 11, 2024

2018 Nov;38(sup1):S16-S31. Among children, hypoglycemia is common and can lead to seizures. Accessed February 26, 2024. link] Williams PCM, Berkley JA. Guidelines for the management of paediatric cholera infection: a systematic review of the evidence. Paediatr Int Child Health. doi: 10.1080/20469047.2017.1409452.

Dehydration 107

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 107

EMDocs

NOVEMBER 2, 2024

bladder incontinence) – 17% Headache – 10% Lighting pains – 10% Often described as sudden, rapidly spreading and disappearing [13] Dizziness – 10% Hearing loss – 10% Seizures – 7% Signs: Hyporeflexia – 50% Sensory impairment (e.g., Sexually transmitted disease surveillance 2018. Symptoms: Personality change (i.e., J Clin Microbiol.

EMS 111

EMS Infectious Diseases CDC Research 111

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. doi:10.1136/bmjgh-2018-001114 Okesanya OJ, Olatunji GD, Kokori E, et al. BMJ Glob Health.

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72