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 118

EKG/ECG Seizures Wellness EMS 118

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

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 87

Seizures Shock Infectious Diseases CPR 87

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 127

EKG/ECG Seizures Hospitals Stroke 127

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.

Administration 98

Administration Emergency Department Seizures Hospitals 98

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 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

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

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 78

Operations Radiology Radiology Fluid Resuscitation 78

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

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 68

Psychiatric Documentation/Coding Radiology Radiology 68

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

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 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

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

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

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

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

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

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

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. However, cardiac syncope is always a differential diagnosis when someone presents with first time seizures. There are a number of things to look for in an ECG that can hint at arrhythmia as the cause of an apparent seizure.

Seizures 115

Seizures EKG/ECG EMS Stroke 115

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

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. 6 Seizures have been observed and are dose-dependent.

Poisoning 102

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 102

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

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 161

Pediatrics CDC Seizures Documentation/Coding 161

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

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 88

Psychiatric Seizures Emergency Department Pediatrics 88

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 83

Stroke Outcomes EMS Seizures 83

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

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 76

Emergency Department Soft Tissue Injuries Airway Management Operations 76

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

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 86

EMS Infectious Diseases Sepsis Hospitals 86

Don't Forget the Bubbles

JULY 10, 2023

Seizures may also occur, as may paralysis. Analgesia is often necessary for the acute phase, as well as antibiotics for secondary bacterial infections. Lancet ID 2023; 23(2):e67-71. link] ; accessed on 6 March 2023. Paralytic polio is not only more common in older patients but also more severe. Encephalitis is rare.

Seizures 75

Seizures Operations Pediatrics Hospitals 75

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

Pediatric Education

SEPTEMBER 1, 2024

Smallpox is an ancient disease and an especially well-known cause of severe morbidity and mortality and therefore was used as a curse or epiphet. The lesions are 7-10 mm in diameter, round, firm, deep-seated and well circumscribed… ” Lesions tend to appear more on the forearms and face than rest of the body. 18 April 2023.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Sepsis 40

EMDocs

MARCH 11, 2024

Published online August 7, 2023. 33 In areas without potable tap water or reliable sources of safe water, bottled water should be used for drinking, as well as brushing teeth and washing/preparing food. Among children, hypoglycemia is common and can lead to seizures. Published online August 7, 2023. 32 Table 3.

Dehydration 102

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 102

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 152

Seizures Stroke Pediatrics Wellness 152