EMDocs

NOVEMBER 6, 2023

Naloxone administration may reverse respiratory arrest, preventing progression to cardiac arrest. Standard advanced life support with the addition of administration of sodium bicarbonate is appropriate for the treatment of life-threatening dysrhythmias caused by cocaine or other sodium channel blockers. COR 2a, LOE B-NR.

Poisoning 93

Poisoning Hyperthermia / Hypothermia Seizures Administration 93

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 63

Seizures Administration Anaphylaxis Outcomes 63

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 113

EMS Fractures Seizures Head Injuries 113

Taming the SRU

DECEMBER 17, 2024

This article serves to briefly discuss IV fluids administration in the ED and the instances where they are not indicated. IV fluid administration was more associated with phlebitis. Considering the nationwide IV fluid shortage, judicious use of fluids is imperative. A systematic review by Freedman et al.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

EMDocs

JANUARY 8, 2024

Avoid routine seizure prophylaxis in adult survivors of cardiac arrest (Level 3: no benefit), but treat seizures if they occur (Level 1: strong). Routine administration of calcium for treatment of cardiac arrest is not recommended. Seizure prophylaxis in adult survivors of cardiac arrest is not recommended.

Seizures 81

Seizures Shock CPR Hyperthermia / Hypothermia 81

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 59

Seizures Administration EMS Wellness 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

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) 92

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 92

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 74

Seizures Fractures EKG/ECG Resuscitation 74

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.

Administration 98

Administration Emergency Department 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

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 6 Seizures have been observed and are dose-dependent. 1 Benzodiazepines are preferred as the first line of treatment for agitation or seizures. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. Innov Clin Neurosci.

Poisoning 89

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 89

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 90

Shock Seizures Airway Management Stroke 90

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 88

Hyperthermia / Hypothermia Poisoning Seizures COPD 88

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 67

Poisoning Seizures Pediatrics EMS 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

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 82

Poisoning Airway Management Seizures PPE 82

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

Taming the SRU

SEPTEMBER 1, 2023

Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

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 75

Poisoning Fluid Resuscitation Seizures Resuscitation 75

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 80

Poisoning Seizures Administration Pediatrics 80

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

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

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

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 66

Sepsis Shock Resuscitation Fluid Resuscitation 66

PulmCCM

DECEMBER 10, 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.

Seizures 52

Seizures Sepsis Academics Administration 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

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

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 66

Operations Radiology Radiology Fluid Resuscitation 66

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

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

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. Resources: S. 2022, February 25). 2018, February 1).

Poisoning 65

Poisoning Fluid Resuscitation Administration Seizures 65

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

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