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

Taming the SRU

DECEMBER 17, 2024

Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Hospitals can purchase ORT packets for use in EDs as well as giving patients the formula to make their own at home. Updated 2023 Oct 22]. AtherlyJohn et al. A systematic review by Freedman et al. References Castera MR, Borhade MB.

Dehydration 84

Dehydration Fluid Resuscitation Administration Resuscitation 84

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. Paper: Freund Y et al.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

PEMBlog

MARCH 4, 2025

Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. After a lull during the COVID 19 pandemic, cases reemerged in 2023 and continued to climb into 2024.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. 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.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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

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 97

Seizures Shock Infectious Diseases CPR 97

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Chemical Burns.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

Inferior Aneurysm morphology is incredibly hard to differentiate from Acute OMI, but you should suspect it whenever there are well-formed inferior Q-waves. 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.

EKG/ECG 115

EKG/ECG Seizures Wellness EMS 115

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

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

ALiEM

JUNE 1, 2023

Well not exactly. NMDA Receptors: Role in Ethanol Withdrawal Seizures. StatPearls Publishing; 2023. Accessed April 16, 2023. Published March 29, 2023. Accessed April 18, 2023. If not, you probably should be. Another old drug for a new indication, right? The American Journal of Emergency Medicine.

Emergency Department 98

Emergency Department Administration Seizures Hospitals 98

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). Caution with use of NIPPV – positive pressure can worsen injury as well as increase subcutaneous emphysema. Am J Emerg Med.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

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. There were some ACEP business decisions at the April Board meeting, as well. 17-23, 2025 in Orlando, Florida.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 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

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

ACEP Now

OCTOBER 3, 2023

In April 2023, the third edition of the Brain Trauma Foundation’s evidence-based guidelines for the prehospital management of traumatic brain injury (TBI) was published in Prehospital Emergency Care. 2023; [link] Centers for Disease Control and Prevention. The GCS must be obtained through interaction with the patient (i.e.,

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Mind The Bleep

OCTOBER 17, 2024

Official statistics from 2023 from SMR tell us the majority of our callouts are trauma, with lower leg and ankle injuries accounting for 57% of callouts. Seizures, chest pain, intoxication, and deliberate self-harm were also reported. From a medical perspective, perhaps the bit you’re more interested in here, how does a doctor fit in?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. 2019 Aug;50(8):2023-2029. Accessed July 19, 2023. Epub 2022 May 17. PMID: 35579034. Divani AA, et al. 119.025514.

Stroke 99

Stroke Outcomes EMS Seizures 99

Sensible Medicine

SEPTEMBER 13, 2024

” This suggested partial, complex seizures with a post-ictal period. Accept that the patient knows more about his symptoms, and may very well know more about his disease, than you do. 1 This never works out well. For the last couple of weeks, I’ve been noticing a foul odor right before the episodes.

Psychiatric 65

Psychiatric Radiology Radiology Documentation/Coding 65

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology. 5, 2023, pp.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

Dr. Smith's ECG Blog

JANUARY 15, 2024

The ECG more clearly demonstrates: Large area under the curve of the T waves in II, II, and aVF as well as V5 and V6 relative to the QRS complexes Straight, angulated ST segments in these same leads Depressed ST segments in V2-V3 (as would be expected in posterior OMI) Cardiology took the patient for immediate angiography.

EKG/ECG 64

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

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

PEMBlog

MARCH 27, 2024

Updated 2023 Jul 17]. Or, well, the ringer called me. They include neurologic dysfunction, which is one of the most common that includes things like developmental delay, regression, AKA loss of developmental milestones, hypotonia, encephalopathy, or seizures. You can contact her via email at egroopman@childrensnational.org.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. There were no injuries and no chest pain and he appeared well. The patient is a 36yo man who was seen for a seizure. I'm highlighting it again, with comments from Ken Grauer below. This was sent to me by Jason Winter. There was no chest pain.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Taming the SRU

APRIL 17, 2023

Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized below. Deadly Nightshade and Jimson Weed are well known among the poisonous plants. Severe cases may result in seizures or coma. Accessed March 19, 2023. Retrieved 22 January 2023. McGraw Hill; 2016.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

PEMBlog

SEPTEMBER 6, 2023

There is abundant evidence showing that routine lab tests in such patients have a very low yield and are not indicated, in adults as well as in children. Hosp Pediatr (2023) 13 (1): 66–71 Acute onset psychosis is relatively rare. Implementation of a Medical Clearance Algorithm for Psychiatric Emergency Patients.

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Contraindicated seizures or porphyria. Minimal histamine release. Cons: Short duration of action. Pain upon injection.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

EMDocs

OCTOBER 5, 2024

ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. Updated 2023 Nov 12]. J Antimicrob Chemother.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Pediatric Education

JUNE 25, 2023

Borate toxicity can cause abdominal pain, diarrhea, emesis, fever, irritability, seizures, and death. Borates can cause skin irritation and there can be some reproductive changes as well. Accessed April 11, 2023. Accessed April 11, 2023. To view images related to this topic check Google Images. Sex Transm Dis.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Outcomes 40

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. 2004 = My Comment by K EN G RAUER, MD ( 1/21 /2023 ): = I thought today's case by Drs. Seizure activity was witnessed in the ED. Is this takotsubo?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. Emerg Radiol 2023. 8 The data in Mayer et al. 9 A later assessment of the VAN score in Beume et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., 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

Pediatric EM Morsels

NOVEMBER 15, 2024

Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! We have even talked about using a ketogenic diet to control seizures , and seizure mimics.

Seizures 154

Seizures Stroke Pediatrics Wellness 154

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

PulmCCM

OCTOBER 23, 2023

Cefepime crosses the blood-brain barrier, and dozens of case reports have associated the drug with seizures, encephalopathy, delirium, and coma, with a possibly increased incidence of neurologic adverse effects among patients with renal failure or sepsis. Pfizer projects $8 billion in Paxlovid sales in 2023.

Hospitals 98

Hospitals COPD Emergency Department CDC 98

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. 2023 Nov;82(5):615-623. Epub 2023 May 13. doi:10.1111/head.12767

Emergency Department 105

Emergency Department Fractures Burns EMS 105