PEMBlog

MARCH 4, 2025

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. There was publication bias, heterogeneity, and lack of blinding. I can’t bear it.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

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.  2022 Mar;18(2):253-255.  J Int Adv Otol. 2020

EMS 120

EMS Fractures Seizures Head Injuries 120

EMDocs

APRIL 10, 2024

She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration.

Advances Cardiac Life Support (ACLS) 111

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

Emergency Medicine Ireland

APRIL 29, 2024

They have a seizure on arrival and a Na comes back at 105. In this scenario they are seizing because of the low Na and rapid increase of the Na is needed to stop the seizure. A seizure seems fairly easy to define but “coma” is a little bit more vague. They have a seizure on arrival and a Na comes back at 105.

Seizures 75

Seizures Sepsis Stroke Administration 75

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

ALiEM

JUNE 1, 2023

Administration of benzodiazepines or barbiturates to these patients risk inducing a prolonged comatose state. The concern with concurrent phenobarbital and benzodiazepine administration is oversedation. There is a dearth of evidence about which patients require medical admission in the setting of phenobarbital administration.

Emergency Department 98

Emergency Department Administration Seizures Hospitals 98

Dr. Smith's ECG Blog

MAY 8, 2014

In 49 patients with known TCA overdose , a maximum limb lead QRS duration greater than 100 ms was 100% sensitive for detecting patients who will seize, and seizure is a harbinger of cardiovascular collapse. Of 14 with initial QRS of 140 ms or longer, 8 (56%) had seizures. Sodium channel blockade in the CNS leads to seizures.

Seizures 52

Seizures EKG/ECG Administration EMS 52

Taming the SRU

JUNE 3, 2024

Get a blood gas when possible to help guide your ventilation. glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

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. In vitro analysis of N-Acetylcysteine (NAC) interference with the International Normalized Ratio (INR). Clinical Toxicology , 60 (4), 489–492. PMID: 21740141.

Poisoning 98

Poisoning Seizures Administration Pediatrics 98

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.

Sepsis 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

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). PPI administration to decrease gastric acid secretion. 5 Consider antifungal administration.

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.

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

RebelEM

OCTOBER 5, 2022

mg/dL 10.5 – 12.0 mg/dL 10.5 – 12.0

Dehydration 52

Dehydration Psychiatric Administration EKG/ECG 52

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.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 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

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.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

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. Sometimes these can also be referred to as guidelines, standing orders, policies, or procedures.

EMS 98

EMS Documentation/Coding Pediatrics Psychiatric 98

Dr. Smith's ECG Blog

DECEMBER 26, 2020

Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion. Thus, it seems that two mistakes may have inadvertently led accidentally to the appropriate administration of thrombolytics!! Long-term outcome is unknown.

EKG/ECG 52

EKG/ECG Stroke Administration 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. Interference with laboratory studies that use light absorption.

Poisoning 52

Poisoning Seizures Administration Pediatrics 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.

Stroke 99

Stroke Outcomes EMS Seizures 99

ACEP Now

AUGUST 9, 2024

More severe systemic reactions like delirium, seizures, limb paralysis, blood pressure changes, respiratory distress, dysrhythmia, myocardial ischemia, and syncope are rare. 8 Systemic Effects Systemic effects are infrequent but can include nausea, diaphoresis, dyspnea, weakness, hypotension, and chills.

Poisoning 52

Poisoning Burns 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 113

Seizures EKG/ECG EMS Stroke 113

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. Newborns are terrible at answering emails. There is a lot of unread unconjugated bilirubin is floating around. The liver and spleen are just not able to keep up.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric EM Morsels

NOVEMBER 3, 2023

ovale to cover the hypnozoite that can stay dormant in the liver and cause a secondary infection in the future Severe Malaria IV artesunate is currently the accepted first line treatment Previously IV quinine was first line, however it was associated with higher incidence of hypoglycemia, cardiac dysrhythmias, seizures, and comas.

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

ALiEM

MARCH 5, 2024

With severe toxicity, patients can have altered mental status, seizures, hyperthermia, and pulmonary edema. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. British Journal of Haematology.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

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

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. But that’s not where it ends. The evidence is a mixed bag.

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. Benzodiazepines are first-line therapy for seizures. Analysis of benzonatate overdoses among adults and children from 1969-2010 by the United States Food and Drug Administration. 11) A bolus dose at 1.5

Poisoning 89

Poisoning Seizures Pediatrics EMS 89

RebelEM

NOVEMBER 16, 2022

benzocaine) Consider the diagnosis in any patient with cyanosis and hypoxia that doesn’t respond to oxygen administration Administer methylene blue to any patient with abnormal vital signs, metabolic acidosis, end organ dysfunction or, a serum level > 25% References: Price DP. Chapter 127. Read more

Seizures 52

Seizures Administration Airway Management COPD 52

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

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. 9 Physostigmine dosing: 0.5-2

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Poisoning Seizures COPD 111

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. The GCS must be obtained through interaction with the patient (i.e., References Lulla A, et al.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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] What are the symptoms of cyanide poisoning?

Poisoning 67

Poisoning Pediatrics Seizures Administration 67