Pediatric EM Morsels

MAY 10, 2024

Add the risk assessment for sudden cardiac death into your workflow Have you ever fainted or had a seizure without warning, during exercise or in response to a loud noise? Pediatr Rev September 2020; 41 (9): 469–480. Have you ever had chest pain or shortness of breath in exercise? 2011;140(4):859-866. doi:10.1378/chest.10-2946

EKG/ECG 271

EKG/ECG Pediatrics Ultrasounds Seizures 271

Don't Forget the Bubbles

JANUARY 29, 2024

A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Despite this, the CFAM still showed ongoing electrical seizure activity.

Seizures 122

Seizures Pediatrics Research Wellness 122

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

APRIL 7, 2023

American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. 2020 Apr 28;4(8):1554-1588. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! doi: 10.1182/bloodadvances.2019001142.

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). doi: 10.1136/bcr-2020-240532. Rates of congenital syphilis are increasing. Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. pallidum invades the bloodstream directly causing spirochetemia in the fetus.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

PEMBlog

SEPTEMBER 13, 2023

Team members and families eagerly await your intervention to halt the seizure and understand its underlying cause. The lack of utility of laboratory testing in children with an unprovoked generalized seizure, or a simple febrile seizure is supported by several observational studies.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2020. 2020, September 26) EM@3AM: Marine Animal Bites and Stings. 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] Edward OJ.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

JournalFeed

JULY 18, 2020

Here is the JournalFeed Podcast for the week of July 13-17, 2020. We cover screening for blunt cerebrovascular injury, benefits of non-invasive ventilation, systemic lupus erythematosus in review, NEOLEV2 RCT - neonatal seizure control, and combatting systemic racism in medicine.

Seizures 52

Seizures 52

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. Epub 2020 Dec 9. 9 Physostigmine dosing: 0.5-2

Hyperthermia / Hypothermia 108

Hyperthermia / Hypothermia Poisoning Seizures COPD 108

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]. However, if PEG is not immediately available, irrigation with water can be initiated. Phenol exposure can lead to significant skin damage and systemic effects. Acute Crit Care. 2019.00647.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

JANUARY 17, 2024

A 2020 National Poison Data System (NPDS) study comparing pre-DSC and post-DSC benzonatate poisonings showed no decrease in the severity nor incidence of benzonatate poisonings reported to US poison control centers. (1) Benzodiazepines are first-line therapy for seizures. There is no specific antidote for benzonatate.

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

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. Cited June 2020]; 4 (11): 1261-1287. Cited June 2020];27: 1407-1410.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Dr. Smith's ECG Blog

JUNE 26, 2023

As I discuss in detail in My Comment at the bottom of the page in the May 24, 2020 post in Dr. Smith's ECG Blog — AV dissociation is not the same as AV block. Seizure activity was witnessed at the scene — and head CT scan showed a small bleed. PEARL # 5: Accelerated junctional rhythms are not common in adults.

EKG/ECG 97

EKG/ECG Seizures Sepsis Operations 97

EMDocs

MAY 15, 2024

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. 2020;4(2):327-355. 2020;10(1):2470.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

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

MAY 28, 2024

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). 2020;4(2):327-355. 2020;10(1):2470.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

ALiEM

SEPTEMBER 27, 2023

Acute hepatitis Disulfiram-like reaction with ethanol consumption Pneumonitis from inhalation of spores Seizures from glutamate agonist activity [Image from Canstockphoto] Reveal the Answer 2. 2020 Feb 21;64(3): e02167-19. What well-known adverse reaction results from ingestion of the pictured mushroom? Antimicrob Agents Chemother.

Seizures 67

Seizures Academics Wellness 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

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. Look for old ECGs Do serial ECGs Do echocardiography == MY Comment by K EN G RAUER, MD ( 10/1/2020 ): == From time to time — it's helpful to "resurface" prior cases that convey timeless important lessons. The patient is a 36yo man who was seen for a seizure.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. Or Benign Early Repolarization? = == MY Comment by K EN G RAUER, MD ( 10/1/2020 — edited on 2/4/2023 — ): == From time to time — it's helpful to "resurface" prior cases that convey timeless important lessons. The patient is a 36yo man who was seen for a seizure.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

EMDocs

NOVEMBER 1, 2023

1 , 2 The most common non-iatrogenic cause is spontaneously due to increased intraesophageal pressure, Boerhaave syndrome, from forceful retching, coughing, straining, seizures, or even childbirth (15% of cases). McGraw-Hill Education; 2020. upper endoscopy, transesophageal echo, etc.). aid=1104586430 Bono MJ. Esophageal Emergencies.

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

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]. 4, 2020, 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

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. Epub 2020 Dec 9. 2020 Jul;158(1):45-47. Epub 2020 Jul 2. ” Journal of the Medical Association of Thailand 103 (2020). Minimal histamine release. Cons: Short duration of action. Pain upon injection. Excellent amnestic and sedative properties. Can be titrated easily.

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

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. As with soldiers in war, we know that as soon as we stop doing, we will start feeling.”

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

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 November 10, 2020 post — for PTA. The March 17, 2023 post — for PTA.

EKG/ECG 65

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

Dr. Smith's ECG Blog

AUGUST 13, 2020

The patient was awake at this point, lactate was 7 mEq/L and so seizure was suspected as the etiology of the transient loss of consciousness and gaze deviation. At this point, they recorded the above 12-lead. The cath lab had been activated and then they sent me the ECG. Cardiology came to assess the patient. Would you give Thrombolytics?

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

Mind The Bleep

FEBRUARY 7, 2024

meningitis), intractable seizures, low GCS, increased risk of aspiration or airway obstruction such as pathological obstruction (e.g. 283-289, 2020. hypoxic ischaemic encephalopathy), metabolic disorders, or muscular problems. Inability to protect the airway can be due to brain injury (e.g. laryngeal oedema.) 5-11, 2022.

Wellness 52

Wellness Seizures Documentation/Coding Operations 52

EMDocs

JANUARY 4, 2024

In 2020, bupropion was the 18 th most-prescribed medication in the USA. 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.

Seizures 84

Seizures EKG/ECG Poisoning Shock 84

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.

Seizures 98

Seizures Stroke Outcomes EMS 98

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. M., & Lipman, G.

Hyperthermia / Hypothermia 87

Hyperthermia / Hypothermia EMS Stroke Seizures 87

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

EMDocs

JUNE 7, 2023

Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. Case Follow-up: The patient required benzodiazepine administration for seizure management and subsequent intubation for airway protection. link] Updated September 14, 2020. Accessed December 14, 2020. 8 Figure 1. Cook Matt, Frey Aaron.

Poisoning 97

Poisoning Airway Management Seizures PPE 97

EMDocs

JUNE 14, 2023

Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. link] Updated September 14, 2020. Accessed December 14, 2020. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. 1, 2 Sensory > Motor neurons with predilection for long axons. CorePendium.

PPE 89

PPE Poisoning Seizures Emergency Department 89

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. Internat J Arrhyth 2020 Uesako H, Fukikawa H, Hashimoto S, et al. Seizure activity was witnessed in the ED. Is this takotsubo?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52