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

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). Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. 2021 Feb 5;14(2):e240532.

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Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

RebelEM

SEPTEMBER 27, 2023

If QRS >100 msec = 33% chance of seizures If QRS >160 msec = 50% of ventricular dysrhythmias Often extrapolated to other sodium channel blocking agents: diphenhydramine, loperamide, cocaine, lamotrigine, Type 1A/1C Anti-Dysrhythmics. Mohan 2021 ) Recall that the subsequently alkalemia will shift potassium intracellular.

Poisoning 105

Poisoning Seizures Administration EKG/ECG 105

JournalFeed

APRIL 24, 2021

It’s the JournalFeed Podcast for the week of Apr 19-23, 2021. We cover leadership through change, IN midazolam for pediatric seizure, hypothermia and young infant sepsis risk, VICTAS RCT, and clinically diagnosing GHB intoxication.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures Sepsis Leadership 52

JournalFeed

DECEMBER 11, 2021

It’s the JournalFeed Podcast for the week of December 6-10, 2021. We cover patient-centered diagnostic excellence, alteplase before endovascular stroke treatment, steroids for pediatric retropharyngeal abscess, LP for febrile seizure, and the new AHA chest pain guideline.

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Seizures Stroke Pediatrics 52

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed August 25, 2022. link] Zafren K, Thurman R, Jones ID. Marine Dermatitis.

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Poisoning Seizures Anaphylaxis Burns 105

JournalFeed

AUGUST 7, 2021

It’s the JournalFeed Podcast for the week of August 2-6, 2021. We cover GRACE-1, communicating stats better, managing seizures after initial control, POCUS for intussusception, and reading STEMI on ECG with a paced rhythm.

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Seizures EKG/ECG 40

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)

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Poisoning Seizures Pediatrics EMS 92

EB Medicine

JUNE 1, 2021

EMplify - June 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Etiology: figure 1 is fantastic. What do paramedics see? Any trauma?

Seizures 52

Seizures Emergency Department EKG/ECG Hospitals 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. 2021 Aug;59(8):698-704. Clin Toxicol (Phila).

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Poisoning Seizures COPD 111

Pediatric EM Morsels

AUGUST 18, 2023

Ross 2021) Predisposing risk factors including older age , trauma to tendons or joints , and a family history of MAEs. Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. Binz 2015).

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Pediatrics Infectious Diseases Seizures Hospitals 130

EMDocs

AUGUST 3, 2023

Massive acetylcysteine overdose associated with cerebral edema and seizures. Anderson, B. Klein-Schwartz, W., & King, J. In vitro analysis of N-Acetylcysteine (NAC) interference with the International Normalized Ratio (INR). Clinical Toxicology , 60 (4), 489–492. link] Heard K, Schaeffer TH. Clin Toxicol (Phila). 2011 Jun;49(5):423-5.

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Poisoning Seizures Administration Pediatrics 98

The Skeptics' Guide to EM

APRIL 10, 2021

Date: April 6th, 2021 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from the NW of Australia. Date: April 6th, 2021 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from the NW of Australia. However, he is also at risk of a seizure and further harm at this level. He had been vomiting that morning.

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Seizures Emergency Department 52

Mind The Bleep

OCTOBER 20, 2023

They can cause a wide array of symptoms, such as seizures, weakness and dizziness, and typically there are clinical features that actively support the diagnosis of FND. Symptoms of FND -Functional seizures (also can be termed dissociative) -Motor symptoms (e.g. Some have high specificity (positive Hoover’s sign) but low sensitivity.

Seizures 52

Seizures Psychiatric 52

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. Updated 2021 Nov 1]. What well-known adverse reaction results from ingestion of the pictured mushroom? Pharmacol Rev. 2012 Jul;64(3):520-39.

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Seizures Academics Wellness 67

Broome Docs

OCTOBER 31, 2022

Epub 2021 Dec 14. 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. 2022 Jul 26:emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Intensive Care Med.

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Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 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.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

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. Neurol Med Chir (Tokyo).

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Seizures Emergency Department Pediatrics Critical Access 52

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. 2021 Feb 1;41(1):25-30. McGraw Hill; Accessed July 21, 2021. Second, how acute is the hyponatremia? Crit Care Nurse. 02080508.

Administration 52

Administration Seizures Emergency Department Wellness 52

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. ” The American Journal of Emergency Medicine 49 (2021): 48-51. 2021 Mar;60(3):265-272. 2021 Jun;60(6):816-817. 2021): e12373. Minimal histamine release. Cons: Short duration of action. Pain upon injection. Excellent amnestic and sedative properties. J Emerg Med.

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Emergency Department Soft Tissue Injuries Airway Management Operations 93

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. 2021 [cited 2023 Nov 30]. What is atypical HUS? Though uncommon, HUS can be deadly.

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Dehydration Infectious Diseases Seizures Pediatrics 59

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. 1992 Mar 14;339(8794):653-5. doi: 10.1016/0140-6736(92)90803-b. PMID: 1347345. Dodd, et al.

Stroke 101

Stroke Outcomes EMS Seizures 101

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] 2021 Jan 1;32(1):37-43.

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Head Injuries Administration Outcomes Seizures 52

ACEP Now

DECEMBER 10, 2023

5 Symptoms of milkweed poisoning may include abdominal discomfort, nausea, vomiting, diarrhea, weakness, lethargy, and confusion, progressing to seizures, heart rhythm changes, and bradycardia. He was observed for several hours and eventually discharged with minimal intervention.

Poisoning 52

Poisoning Seizures Documentation/Coding Emergency Department 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Method and Design We conducted an observational retrospective cohort study on patients who visited ED in 2021. Abstract 2086 Table 1 Presentations Total first presentation over 2021 Total deaths (within 30 days ) Admission Admission (%) Percentage of deaths [CI ] INJURY OF SHOULDER/ARM/ELBOW/WRIST/HAND 8416 4 424 5 0.05[0.018

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Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

Taming the SRU

FEBRUARY 22, 2023

Paske et al.

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 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. 2021 Nov;30(11):106064.

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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. C., & Mathai, D.

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Hyperthermia / Hypothermia EMS Stroke Seizures 96

PEMBlog

JULY 10, 2024

“Sexually Transmitted Disease Surveillance 2021.” ” Centers for Disease Control and Prevention, 2021. “Sexually Transmitted Infections Treatment Guidelines 2021.” ” Centers for Disease Control and Prevention, 2021. ” Centers for Disease Control and Prevention, 2021.

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Pediatrics CDC Seizures Emergency Department 52

Pediatric EM Morsels

OCTOBER 6, 2023

The most common countries of acquisition were Bangladesh, India, Nepal, and Pakistan (Forster 2021) For travelers, the peak incidence occurs at age 10 and those who are visiting to their country of birth. Rauniyar 2021) Up to 10% of patients may present with constipation as opposed to diarrhea. Shah 2021).

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Pediatrics CDC Seizures Documentation/Coding 164

Taming the SRU

NOVEMBER 13, 2024

opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line. 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

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

EMDocs

NOVEMBER 13, 2023

2021) found that the top 5 reasons for ordering a CTA head/neck were suspected stroke, neurologic problem, dizziness, headache with new/concerning symptoms, and altered mental status. RadioGraphics 2021, 41 (3), E81-E89. Aging Dis 2021, 12 (4), 1000-1009. AJNR Am J Neuroradiol 2021, 42 (4), 743-748. Heilbrun, M.

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Stroke Radiology Radiology Emergency Department 105

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. 2021 Apr;28(4):444-454. Epub 2021 Jan 2. Acad Emerg Med.

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Emergency Department Fractures Burns EMS 105

Pediatric EM Morsels

MARCH 7, 2025

It is excreted by urine so careful dosing is required if used in kidney disease. of IV form TXA [O’Neill 2020] Inexpensive ! of IV form TXA [O’Neill 2020] Inexpensive !

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Pediatrics Blood Transfusions Anaphylaxis Military 231

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. 2021 Oct;10(10):2858-2874. However, this characteristic may not be present in partially immunised patients or if a secondary bacterial infection develops. Transl Pediatr.

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Pediatrics Outcomes Blood Transfusions Sepsis 59

EMDocs

APRIL 1, 2025

Most common issues include vision loss, cranial nerve (CN) palsies, pituitary dysfunction, hemiparesis, facial disfigurement, seizures, cortical vein thrombosis. Mental status changes, seizures, focal deficit may occur. 2021 Nov-Dec;66(6):1021-1030. 2021 Nov-Dec;66(6):1021-1030. What is the anatomy? Surv Ophthalmol.

Dehydration 97

Dehydration Sepsis Seizures Resuscitation 97

EMDocs

JANUARY 22, 2025

These included seizures, delirium, ARDS, hypotension, hypertension, and aspiration. Drug Overdose Deaths with Evidence of Counterfeit Pill Use – United States, July 2019-December 2021. drug seizure data, 2011-2016. 2021 Mar 17;22: e929412. The median IV dose administered was 0.2mg, and the median IM dose was 0.2

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Seizures Administration Emergency Department Poisoning 97