Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

Shock 92

Shock Seizures Airway Management Stroke 92

EMDocs

AUGUST 17, 2023

The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm. vs 48.4% (OR 3.4,

Sepsis 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

EMDocs

JUNE 9, 2023

How do we manage the agitated child in the pre-hospital environment? After listening to this episode you will be able to: Identify unique aspects of the pre-hospital environment that impact assessment and treatment of agitated children Describe the role of EMS personnel and EMS director in the care of agitated children. mg/kg IN; 0.1-0.15

EMS 97

EMS Documentation/Coding Pediatrics Psychiatric 97

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 92

Operations Radiology Radiology Fluid Resuscitation 92

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. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 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. Of note, you do NOT need a central line for hypertonic saline administration. Second, how acute is the hyponatremia? Crit Care Nurse.

Administration 52

Administration Seizures Emergency Department Wellness 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Both of these also cause seizures. Here is the history : Male in 40's who had seizures and was unconscious. Second , if the patient is hemodynamically stable, without pulmonary edema, it may be wise to try some fluids and and benzodiazepines and/or propofol for this post-seizure patient with likely high catecholamine levels.

Seizures 52

Seizures Administration Outcomes Hospitals 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

His friend was able to get him into the truck and drive him to a nearby community hospital (non-PCI center). Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion. Long-term outcome is unknown.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

EMDocs

JANUARY 29, 2024

hypertensive emergency, need for thrombolytic administration) [1]. 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. doi: 10.1161/STR.0000000000000407.

Stroke 98

Stroke Outcomes EMS Seizures 98

Pediatric Emergency Playbook

MAY 1, 2017

Also, newborns have a double-whammy administrative load. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. Hospital Stay for Healthy Term Newborn Infants. Newborns are terrible at answering emails. There is a lot of unread unconjugated bilirubin is floating around. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 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 112

Seizures EKG/ECG EMS Stroke 112

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). More specifically they have seen this trend continue to rise in the era of post-COVID travel (Choy 2022). vivax and P. malariae , and P.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

DECEMBER 6, 2024

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Antiemetics as needed.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

EMDocs

MAY 25, 2023

Design: Multi-centered, double-blinded, randomized trial PICO: Population: Inclusion Criteria: Age 2 years and older Must have been treated with a specified minimum dose of certain benzodiazepines for generalized convulsive seizures: Intravenous or rectal diazepam 0.3 mg/kg or 10 mg Intravenous lorazepam 0.1

Seizures 88

Seizures Administration Anaphylaxis Outcomes 88

Don't Forget the Bubbles

APRIL 7, 2025

It can present with jitteriness, poor feeding, prolonged jaundice, seizures, bluish skin discolouration (cyanosis), lethargy, or even acute collapse. Depending on the size and location, children may develop neurological symptoms, such as seizures, developmental delays, or visual disturbances due to compression of the optic pathways.

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

Don't Forget the Bubbles

FEBRUARY 5, 2025

All hospitals will have different makeups of trauma teams and possibly different levels of activation) Do I need any additional expertise outside of who would typically be in the trauma team? Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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. in the placebo group).

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ACEP Now

OCTOBER 3, 2023

Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day. References Lulla A, et al.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

EMDocs

JANUARY 17, 2024

The US Food and Drug Administration (FDA) approved benzonatate in 1958 for cough relief in patients ≥ 10 years. High performance liquid chromatography (HPLC) is possible for quantitative analysis; however, most hospitals do not have it readily available and is unlikely to result in a clinically relevant timeframe.

Poisoning 88

Poisoning Seizures Pediatrics EMS 88

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

ACEP Now

APRIL 2, 2024

1 In severe cases altered mental status, seizures, coma, or even death have been observed. Due to concerns regarding THS, the import of ackee fruit was outlawed in 1972, but since 2000 canned exports have been allowed by certain “green listed” manufacturers by the Federal Drug Administration. Food and Drug Administration website.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. Also, be aware that there are various formulations of cannabis that allow for different routes of administration. Jeff: On that note, we should also touch on cannabis withdrawal.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. This post focuses on pain management for benign headaches.

Emergency Department 106

Emergency Department Fractures Burns EMS 106

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score. Other studies 1) EGSYS score (full text link).

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EB Medicine

FEBRUARY 1, 2019

Let’s talk pre hospital care for headache patients. As was the case for your pre-hospital colleagues, you should also assess for red flag signs for life-threatening headaches. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. Seizures are very common as well.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

Taming the SRU

SEPTEMBER 1, 2023

Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 96

Sepsis Fractures Documentation/Coding Administration 96

EMDocs

JANUARY 22, 2025

What are the pharmacokinetics of naloxone and how do they vary by route of administration? These included seizures, delirium, ARDS, hypotension, hypertension, and aspiration. Route of Administration and Pharmacokinetics 7,11-14 Route Dose Onset (minutes) Time to peak effect (minutes) t Duration IV 0.04-2mg* 2mg* 2 5 0.5-1.5

Seizures 96

Seizures Administration Emergency Department Poisoning 96

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. Millions are poisoned, and hundreds of thousands die each year worldwide. 8 Figure 1.

Poisoning 98

Poisoning Airway Management Seizures PPE 98

Don't Forget the Bubbles

AUGUST 13, 2023

Most febrile seizures are generalized tonic clonic seizures, lasting for a few minutes (less than 10 mins) and are conventionally classified as being simple (70%) and complex (30%). Simple febrile seizures are generalized (i.e. Any febrile seizure lasting for > 30 mins is considered febrile status epilepticus.

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

Don't Forget the Bubbles

DECEMBER 9, 2024

These include CNS irritability (agitation, seizures, irritability), GI disturbance (nausea, vomiting, diarrhoea), and autonomic symptoms (increased heart rate, high blood pressure, sweating and fever). Duration of drug administration in days e.g. 8 days of midazolam infusion. 2021.10296 Childrens Hospital of Philadelphia.

Pediatrics 59

Pediatrics Sepsis Hospitals Administration 59

Taming the SRU

JUNE 6, 2023

HAJDU Mild TBI’s & Concussions in the Emergency Department TBI’s are relatively common >3 million TBI’s in the US annually 2.5 million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

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., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1

Psychiatric 90

Psychiatric Seizures Emergency Department Pediatrics 90

PulmCCM

OCTOBER 23, 2023

Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin. Paxlovid also did not reduce symptoms of Covid-19 in that trial.

Hospitals 98

Hospitals COPD Emergency Department CDC 98

EMDocs

JULY 19, 2023

Further, organic mercury readily crosses the placenta where it acts as a teratogen leading to a wide range of birth defects including developmental delay, blindness, seizures, and limb malformation. Food and Drug Administration. Food and Drug Administration. Mercury concentrations were not measured in dialysate. Resources: S.

Poisoning 91

Poisoning Fluid Resuscitation Administration Seizures 91

Don't Forget the Bubbles

JULY 5, 2023

GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. At home, he has had 24 hours of alternating paracetamol and ibuprofen, but the pain was so unbearable that his parents came to hospital in the middle of the night. What medications would you give to control pain in hospital?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

MARCH 11, 2024

Oral antibiotic administration should take place for patients with severe cholera infection as soon as they are able to tolerate oral intake, which usually occurs after rehydration and administration of antiemetics. Among children, hypoglycemia is common and can lead to seizures. Trop Med Infect Dis. 2023;8(3):169. Kirk M, ed.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111