Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. Progression through Return to Learn and Return to Sport:[ Patricios, 2023 ] Is individualized and based on the person’s symptoms Typically takes a minimum of 1 week. Now highlights the scholastic component!

Seizures 281

Seizures Pediatrics Academics Emergency Department 281

EMDocs

JANUARY 8, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline Updates for 2023 were just published. Avoid routine seizure prophylaxis in adult survivors of cardiac arrest (Level 3: no benefit), but treat seizures if they occur (Level 1: strong). 2023 Dec 18.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

Northwestern EM Blog

FEBRUARY 4, 2025

Written by: Dean Hayes (NUEM 27) Edited by: Andrew Long (NUEM 25 ) Expert Commentary by: Rafael Lima, MD A mid 20s male presents to the ED after seizure-like activity. Per the patient's partner at bedside, he had a 2-3 minute convulsive episode and the description is consistent with a likely seizure. and Can Kratom cause seizures?

Seizures 72

Seizures Poisoning Forensics Emergency Department 72

EMDocs

MARCH 4, 2025

Neurologic deficits, seizures, cognitive issues, hearing loss. Give acyclovir If there is concern for HSV encephalitis (focal neurologic deficits, seizures, markedly depressed mental status, or immunocompromise) The mortality rate for HSV encephalitis is up to 70%. 2023 Mar;65:76-83. Mortality rate is 10-30%. Am J Emerg Med.

Infectious Diseases 85

Infectious Diseases Seizures Poisoning Sepsis 85

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. in a 2023 systematic review and meta-analysis. Treasure Island (FL): StatPearls Publishing; June 25, 2023. 2023; 173:158-166.e2. Kochanek et al. In: StatPearls.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

ACEP Now

FEBRUARY 18, 2025

Emergency medical services (EMS) were called to the home of a 22-year-old woman after a syncopal episode and seizure-like activity. Woman with syncopal episode and seizure-like activity , 216-218, 2023 by the American College of Emergency Physicians.

EKG/ECG 52

EKG/ECG Seizures Emergency Department EMS 52

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. Flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

Pediatric EM Morsels

AUGUST 9, 2024

Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Congenital syphilis differs from syphilis contracted by an “adult” in that: [ Hussain, 2023 ] T. Hussain, 2023 ] Excellent prognosis if treated early. Congenital syphilis is classified as either Early or Late. From asymptomatic to stillbirth.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

RebelEM

FEBRUARY 15, 2024

There has been no high level evidence to help guide practice until now…the Non-Invasive Airway Management of Comatose Poisoned Emergency Patients (NICO) trial. Paper: Freund Y et al. Effect of Noninvasive Airway management of Comatose Patients with Acute Poisoning: A Randomized Clinical Trial. References: Freund Y et al.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

Taming the SRU

DECEMBER 17, 2024

Updated 2023 Oct 22]. IV fluid hydration is required in head trauma and hypercalcemia for osmotic gradient balance and for correction for volume depletion caused by hypercalcemia-induced diabetes insipidus, respectively. References Castera MR, Borhade MB. Fluid Management. In: StatPearls [Internet].

Dehydration 84

Dehydration Fluid Resuscitation Administration Resuscitation 84

PulmCCM

JANUARY 29, 2024

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. Seizure prophylaxis was advised against, as there is no evidence for its efficacy. Here’s PulmCCM’s take on the new changes.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

Don't Forget the Bubbles

JUNE 30, 2023

And hot off the press… the international PATCH ( P rehospital A ntifibrinolytics to T rauma C oagulopathy and H aemorrhage) study (just published on 14th June 2023) compared a prehospital TXA bolus, followed by an eight-hour infusion with placebo in more than 1300 adult patients from 21 hospitals across three countries. 2023 Jun 14.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ALiEM

OCTOBER 27, 2023

He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Nothing made it better or worse.

Seizures 111

Seizures Academics 111

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. Treat seizures if present.

Seizures 98

Seizures Shock Infectious Diseases CPR 98

PEMBlog

MARCH 4, 2025

After a lull during the COVID 19 pandemic, cases reemerged in 2023 and continued to climb into 2024. 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.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

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. 2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. J Matern Fetal Neonatal Med.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

EMDocs

MARCH 2, 2024

Seizure as Early Presentation of a Pneumocephalus after Cochlear Implant: A Case Report. J Treasure Island (FL): StatPearls Publishing; March 20, 2023. 2023, January). The most common causes include trauma and cranial surgeries, but there are other etiological factors, and in rare cases, it can also be spontaneous. [1-3]

EMS 119

EMS Fractures Seizures Head Injuries 119

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. Accessed April 15, 2023. 2023; 19(3):284-287.

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Poisoning Seizures COPD 111

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]. Updated 2023 Jul 17]. Updated 2023 Jul 17]. However, if PEG is not immediately available, irrigation with water can be initiated. Chemical Burns. In: StatPearls [Internet].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

EKG/ECG 124

EKG/ECG Seizures Hospitals Stroke 124

Board Bombs

APRIL 2, 2023

What if we told you there was a type of stroke that affected young people, caused more seizures than "typical arterial strokes", and the typical ED imaging does not diagnose it. link] April 3nd, 2023. link] April 3nd, 2023. Scared yet? You should be. Want to experience the greatest in board studying? Episode 171. Scared yet?

Stroke 52

Stroke Seizures 52

Board Bombs

APRIL 2, 2023

What if we told you there was a type of stroke that affected young people, caused more seizures than "typical arterial strokes", and the typical ED imaging does not diagnose it. link] April 3nd, 2023. link] April 3nd, 2023. Scared yet? You should be. Want to experience the greatest in board studying? Episode 171. Scared yet?

Stroke 52

Stroke Seizures 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

No chest pain, no shortness of breath, no back pain, no numbness, weakness, tingling, no seizures or history of seizures, First ED ECG This still shows apparent inferior OMI. What do you think about cath lab activation? On arrival in the ED, the patient denied any symptoms at all.

EKG/ECG 115

EKG/ECG Seizures Wellness EMS 115

ALiEM

JUNE 1, 2023

NMDA Receptors: Role in Ethanol Withdrawal Seizures. StatPearls Publishing; 2023. Accessed April 16, 2023. Published March 29, 2023. Accessed April 18, 2023. The American Journal of Emergency Medicine. 2011;29(4):382-385. doi:10.1016/j.ajem.2009.10.010. 2009.10.010. Annals of the New York Academy of Sciences.

Emergency Department 98

Emergency Department Administration Seizures Hospitals 98

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. 2023 Mar;97(3):651-661. Provide supportive care. 359.6371.23.

Poisoning 78

Poisoning Seizures Hospitals 78

Taming the SRU

JUNE 3, 2024

Knowing the capabilities of your system BEFORE disaster strikes is crucial top 10 air care cases of 2023-2024 with drs. Get a blood gas when possible to help guide your ventilation.

Shock 91

Shock Seizures Airway Management Stroke 91

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

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. Published 2023 Feb 23.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

Taming the SRU

SEPTEMBER 24, 2023

Patients with a history of seizures, supratentorial structural brain pathologies, post-arrest, or unexplained altered mental status should prompt suspicion for NCSE. However, Ceribell is a useful technology to help detect seizure activity and affect disposition. Two main theories behind the development of PRES. (1)

Seizures 52

Seizures EKG/ECG Emergency Department Shock 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). Accessed September 30, 2023. Accessed September 30, 2023. Accessed October 1, 2023. aid=1104586430 Bono MJ.

Operations 95

Operations Radiology Radiology Fluid Resuscitation 95

ACEP Now

JUNE 14, 2024

And the Board approved a new clinical policy, “Critical Issues in the Management of Adult Patients Presenting to the ED with Seizures,” rescinding the 2014 clinical policy with same title. The Public Health Committee will develop a Policy Statement on this topic.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 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

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]. 2019 [cited 2023 Nov 30]. What is atypical HUS?

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Don't Forget the Bubbles

SEPTEMBER 6, 2023

A 2023 Quality Improvement (QI) project involved the introduction of a medical clearance algorithm for children presenting with psychiatric emergencies. Investigations may also be necessary for the assessment of severe self-harm (such as deep lacerations or hanging) or the evaluation of potential sexual abuse.

Psychiatric 119

Psychiatric Sexual Assault Emergency Department Pediatrics 119

ACEP Now

FEBRUARY 11, 2024

Patient C, a 27-year-old female with a history of epilepsy, taking valproate and endorsing adherence, is then brought in by ambulance for a witnessed seizure. This is her first seizure in six years. This patient had her first seizure in years despite adherence to her valproate for management of her epilepsy. Diabetes Care.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

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.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

ALiEM

DECEMBER 4, 2023

Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Open Med (Wars). 2018 May 9;13:158-163. doi: 10.1515/med-2018-0025. PMID: 29756051; PMCID: PMC5941707.

Academics 60

Academics Seizures Hospitals Emergency Department 60