Don't Forget the Bubbles

JUNE 30, 2023

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. There was a small increased risk of seizures in the TXA group – 0.3% (7 children) of the 1900 children in the TXA group vs none of the 1900 children in the non-TXA group. Pediatr Crit Care Med. But that’s not where it ends.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

JANUARY 17, 2024

The US Food and Drug Administration (FDA) approved benzonatate in 1958 for cough relief in patients ≥ 10 years. 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) 9) In 2019, benzonatate accounted for ~ 10% of all pediatric antitussive prescriptions dispensed via retail pharmacies. (9)

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

EMDocs

MARCH 2, 2024

A) Administration of mannitol B) Admission for observation C) Discharge home D) Discharge home with oral steroids Answer: B The patient has a skull fracture with an overlying laceration. Administration of mannitol (A) is indicated for patients with elevated intracranial pressure.  An Pediatr (Engl Ed). 2019 Surg Neurol Int. 

EMS 119

EMS Fractures Seizures Head Injuries 119

RebelEM

JULY 10, 2024

Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Red flags in patients with headaches that may suggest a brain tumor include signs of increased intracranial pressure, focal neurological signs, seizures or ataxia. Post Peer Reviewed By: Salim R.

Seizures 58

Seizures Administration EMS Wellness 58

EMDocs

JUNE 9, 2023

These protocols are often developed in collaboration with multiple stakeholders that can include EMS staff and administration, legal counsel, community members, law enforcement. If you have restraints in your ambulance, are those restraints appropriately sized for pediatric patients?

EMS 95

EMS Documentation/Coding Pediatrics Psychiatric 95

EMDocs

AUGUST 3, 2023

IV is usually recommended due to faster onset, ease of administration, and shorter protocol duration. Massive acetylcysteine overdose associated with cerebral edema and seizures. Pediatr Emerg Care. link] Heard K, Schaeffer TH. Clin Toxicol (Phila). 2011 Jun;49(5):423-5. doi: 10.3109/15563650.2011.583664. PMID: 21740141.

Poisoning 97

Poisoning Seizures Administration Pediatrics 97

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.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

ALiEM

NOVEMBER 15, 2023

1,6,7] Dizziness, confusion, headache Shortness of breath Weakness and malaise Nausea and vomiting Hypotension, seizures, coma, apnea, arrhythmias Death due to cardiorespiratory arrest How do you diagnose cyanide poisoning? [7] Dosing for 3% sodium nitrite solution [8]: Adults: 300 mg (10 mL) no faster than 5 mL/min Pediatrics: 6 mg/kg (0.2

Poisoning 67

Poisoning Pediatrics Seizures Administration 67

Cook County EM Blog

MAY 29, 2023

Signs and symptoms of toxicity include alerted mental status, seizures, CNS depression, apnea, respiratory failure, hypotension, ventricular dysrhythmias, and cardiac arrest. If a therapeutic dose is chewed, it can lead to bronchospasm, laryngospasm, seizures, and cardiovascular collapse which further reinforces the danger to children.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

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. In a metropolitan area, pediatric patients with severe TBI should be transported directly to a pediatric trauma center if available.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

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

MARCH 28, 2022

Clinical Findings of Methanol Poisoning CNS sedation Seizures Rapid, Deep Breathing Hypotension Ocular findings: Blindness Afferent pupillary defect Optic disk hyperemia Mydriasis Ethylene Glycol Toxicity Similarly, the toxic metabolites of ethylene glycol cause end-organ damage at levels greater than 20mg/dl. Journal of Pediatrics.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

Pediatric Emergency Playbook

MAY 1, 2017

Also, newborns have a double-whammy administrative load. Pediatrics. Pediatrics. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. Pediatrics. Pediatrics. Pediatrics. Pediatrics. Newborns are terrible at answering emails. Can I go Home Now?

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

ALiEM

AUGUST 16, 2023

Dyspnea Headache Syncope Coma Seizures How can you diagnose methemoglobinemia? Adverse Effects of Methylene Blue Pain at infusion site Blue discoloration of urine and serum Interferes with pulse oximetry, resulting in falsely low readings after administration. Pediatr Rev. J Cardiothorac Vasc Anesth. 2014;28(4):1043-1047.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

Taming the SRU

MAY 30, 2023

Comiskey Hyperammonemia 10% of of patient presenting with hepatic encephalopathy do not have elevated ammonias Most commonly seen in adults is secondary to liver dysfunction with cirrhosis or portal venous system shunting.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Taming the SRU

SEPTEMBER 1, 2023

Can also extend this logic to those with TBI’s or trauma patients are inebriated Can attempt try to mitigate the risk and harm associated with iWBCT’s Future use of low-dose iWBCT Full-body MR imaging is already being used in pediatric patients Logistic regression in REACT-2 patient population identified 10 characteristics to warrant iWBCT in patients (..)

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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

EMDocs

JUNE 7, 2023

mg/kg pediatrics) Double dose every 5 min Titrate up to end point of therapy and may require very large doses Target End Point of Therapy = clear chest sounds, HR > 80/min, pupil size greater than pinpoint, and dry axillae. Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. See figure below.

Poisoning 97

Poisoning Airway Management Seizures PPE 97

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. This post focuses on pain management for benign headaches. Emerg Med J.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

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 64

Documentation/Coding Seizures Psychiatric Wellness 64

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 91

Seizures Administration Emergency Department Poisoning 91

Don't Forget the Bubbles

JULY 5, 2023

Do not use pethidine since it can cause seizures and CNS hyperexcitability. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

NOVEMBER 13, 2024

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

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

PEMBlog

MAY 9, 2024

Febrile Seizures are among the most common neurological problema in young children, occurring in 1 out of 50 children between the ages of 6 months and 5 years of age. Febrile Seizure. Common variants associated with general and MMR vaccine-related febrile seizures. Pediatrics. Updated 2024 Jan 19]. Ann Emerg Med.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

Don't Forget the Bubbles

DECEMBER 9, 2024

Clinical recommendations for pain, sedation, withdrawal, and delirium assessment in critically ill infants and children Pediatric Acute Lung Injury and Sepsis Investigators ( PALISI ). Duration of drug administration in days e.g. 8 days of midazolam infusion. Pediatr Crit Care Med. Transl Pediatr. 2023;207(1):17-28.

Pediatrics 59

Pediatrics Sepsis Hospitals Administration 59

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. Pediatr Infect Dis J. 2013;8(1):e54395.

Dehydration 107

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 107