Don't Forget the Bubbles

NOVEMBER 11, 2024

Therapeutic hypothermia is thought to decrease the brain’s metabolic demand, reduce inflammation and cell death, and reduce the risk of seizures. explored the evidence in a 2019 systematic review, which forms part of the Brain Trauma Foundation Guidelines, as did Utsumi et al. 2019 Apr;20(4):404]. Kochanek et al.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ). Article : Peter-Derex et al.

Seizures 129

Seizures Stroke Outcomes Research 129

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 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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

MAY 25, 2023

Design: Multi-centered, double-blinded, randomized trial PICO: Population: Inclusion Criteria: Age 2 years and older Must have been treated with a specified minimum dose of certain benzodiazepines for generalized convulsive seizures: Intravenous or rectal diazepam 0.3 Editor Note: The key to status epilepticus is to stop the seizure.

Seizures 91

Seizures Administration Anaphylaxis Outcomes 91

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. McGraw Hill Companies, Inc; 2019. mL/kg/min. [2]

Advances Cardiac Life Support (ACLS) 111

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

PEMBlog

MARCH 4, 2025

Clin Infect Dis 2019; 68:13. Patients can get joint pain, you can have a hemolytic anemia due to IgM antibodies causing an autoimmune hemolysis, or even neurological complications such as meningoencephalitis, seizures, transverse myelitis, or even Guillain Barre syndrome. 2024 Dec;56(1):2386636. doi: 10.1080/07853890.2024.2386636.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

Don't Forget the Bubbles

JUNE 30, 2023

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. 2019 Nov 9;394(10210):1713-1723. Epub 2019 Oct 14.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Rates of congenital syphilis are increasing.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

Don't Forget the Bubbles

SEPTEMBER 6, 2023

A 2022 CDC report showed an overall trend of increasing mental health-related ED visits for children and young people aged 0-17 from 2019 to 2022. Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic – United States, January 2019-January 2022. 2022;71(8):319-324.

Psychiatric 119

Psychiatric Sexual Assault Emergency Department Pediatrics 119

Mind The Bleep

OCTOBER 29, 2024

These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. However, if PEG is not immediately available, irrigation with water can be initiated. J Med Toxicol. 2015 Jun;11(2):227-31. 2019.00647.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2019. McGraw Hill; 2019. 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. link] Blohm E, Brush D. Marine Envenomations. link] Yip K.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

EMDocs

FEBRUARY 15, 2024

Physostigmine does not reverse seizures or dysrhythmias. 7 Administer this antidote slowly via intravenous route over several minutes (5-10 minutes), as rapid administration is associated with seizures and bradycardia. Physostigmine does not reverse seizures or dysrhythmias. McGraw Hill; 2019. McGraw-Hill Education; 2019.

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Poisoning Seizures COPD 111

EMDocs

JANUARY 17, 2024

5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) 9) In 2019, benzonatate accounted for ~ 10% of all pediatric antitussive prescriptions dispensed via retail pharmacies. (9) 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) Benzodiazepines are first-line therapy for seizures.

Poisoning 92

Poisoning Seizures Pediatrics EMS 92

EMDocs

JUNE 22, 2024

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. If AFE occurs during labor, immediate delivery is recommended. Electronic address, p. link] j.ajog.2016.03.012

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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. 2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463.

Poisoning 78

Poisoning Seizures Hospitals 78

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation. ) — but I’ve enjoyed being able to get very close to computer-calculated QTc values by this simple correction factor method.

EKG/ECG 124

EKG/ECG Seizures Hospitals Stroke 124

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. He reports no personal or familial history of seizures. The physicians quickly recognized that this was not a seizure and likely cardiac in nature.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Pediatric EM Morsels

AUGUST 18, 2023

Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. So, in the right clinical situtation, the benefits of the fluoroquinolone use in children may outweigh the risk. Clin Pediatr. Pediatrics.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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. 2019 Apr;20(4):404].

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

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.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

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. Stroke 2019; 50:e344. 2019 Aug;50(8):2023-2029. Epub 2019 Jun 20.

Stroke 101

Stroke Outcomes EMS Seizures 101

EMDocs

AUGUST 22, 2023

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Ann Emerg Med.

Emergency Department 95

Emergency Department Blood Transfusions Resuscitation Sepsis 95

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. He is not on anticoagulation and there is no history of seizures. There are no other external signs of trauma on your exam.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Pediatrics 2019 Guest Skeptic: Dr. Katie Noorbakhsh is a pediatric emergency physician at the Children’s Hospital of Pittsburgh. Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs).

Pediatrics 52

Pediatrics Seizures CPR Hospitals 52

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. 2019 [cited 2023 Nov 30]. 2019 Sep 25;8:1690. 2019 [cited 2023 Nov 30].

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

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] McGraw Hill; 2019. McGraw Hill; 2019. What are the symptoms of cyanide poisoning? Malashock H.

Poisoning 67

Poisoning Pediatrics Seizures Administration 67

Taming the SRU

MARCH 14, 2023

Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. The seizure abated with rectal diazepam given by the squad. You notice a med-alert bracelet with the patient’s name and the word “SEIZURES.” His abdomen is soft. Neuroanatomy.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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]. 3, 2019, pp. In patients with an abnormal CT Head, decisions regarding management and disposition should be made in conjunction with a Neurosurgeon. These patients are often admitted to the hospital.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

Northwestern EM Blog

JANUARY 10, 2022

Hypertonic saline is not only indicated for seizures, coma, suspected cerebral herniation or focal neurological deficits as noted above. Seizures attributed to hyponatremia need treatment ASAP. 2019 Apr;56(4):431-436. Epub 2019 Feb 8. Second, how acute is the hyponatremia? Third, how severe are the symptoms? J Emerg Med.

Administration 52

Administration Seizures Emergency Department Wellness 52

ALiEM

AUGUST 16, 2023

Dyspnea Headache Syncope Coma Seizures How can you diagnose methemoglobinemia? 2019, McGraw-Hill Education: New York. 2019, McGraw-Hill Education: New York. 4] The most common confirmatory test for methemoglobinemia is co-oximetry (multiple-wavelength oximetry) and results are usually reported as a percentage of methemoglobin.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

This was the etiology of seizures. No more abnormal U-waves == MY Comment, by K EN G RAUER, MD ( 11/18/2019 ): == LOTS of great points regarding use of the ECG in association with electrolyte abnormalities. Case outcome The Na was 109. He was treated with hypertonic saline. Volume was down, and so repleted.

EKG/ECG 52

EKG/ECG Seizures Stroke Wellness 52

Dr. Smith's ECG Blog

MARCH 19, 2019

Although the QT is very long, long QT due to hypocalcemia is rarely associated with Torsades de Pointes. == Comment by K EN G RAUER, MD ( 3/19/2019 ): == There are a number of ECG patterns that should immediately suggest a clinical diagnosis. Here was a repeat ECG: QTc 523. Long ST segment remains. This is one of them!

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

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 September 22, 2019 post — intermittent ST-T wave artifact.

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64