EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity.

Seizures 73

Seizures Documentation/Coding EKG/ECG Emergency Department 73

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. Movement Disorder Emergencies. His roommate found an empty pill bottle on the floor next to him. 2022;15:3915-3929.

Poisoning 91

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 91

EMDocs

JUNE 9, 2023

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. That includes the patient, EMS personnel, and general public.

EMS 78

EMS Documentation/Coding Pediatrics Psychiatric 78

Taming the SRU

FEBRUARY 5, 2024

Traumatic brain injury (TBI) accounts for millions of Emergency Department visits annually. While moderate and severe TBI is often managed on an inpatient basis, patients presenting with mild TBI, or concussion, are often managed solely by Emergency physicians. Acetaminophen, NSAIDs, and antiemetics are all reasonable choices.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

EMDocs

JANUARY 17, 2024

When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Benzodiazepines are first-line therapy for seizures.

Poisoning 68

Poisoning Seizures Pediatrics EMS 68

EMDocs

FEBRUARY 15, 2024

8 However, it is not considered first line in treatment of anticholinergic toxicity and is not available in all emergency departments. Physostigmine does not reverse seizures or dysrhythmias. Physostigmine does not reverse seizures or dysrhythmias. 9 Physostigmine dosing: 0.5-2 mg; for children, can use 0.02

Hyperthermia / Hypothermia 91

Hyperthermia / Hypothermia Poisoning Seizures COPD 91

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. Parenteral organophosphorus poisoning in a rural emergency department: a case report.

Poisoning 84

Poisoning Airway Management Seizures PPE 84

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

She is interested in social determinants of health in the emergency department and health policy. Dr. Ian Holley is also a PGY-3 resident in Emergency Medicine at Washington University School of Medicine in St. He is interested in ultrasound and international emergency medicine.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

EMDocs

DECEMBER 6, 2024

Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Consider intubation for patients with airway compromise, respiratory failure, altered mental status, or seizure. 5 Seizure: IV benzodiazepine first line, barbiturates as second line.

Poisoning 77

Poisoning Fluid Resuscitation Seizures Resuscitation 77

EMDocs

JUNE 14, 2023

Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. Parenteral organophosphorus poisoning in a rural emergency department: a case report. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. Limit exposure with PPE if returning to the exposing environment.

PPE 71

PPE Poisoning Seizures Emergency Department 71

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. He appears well and is triaged to an ESI 4.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

PEMBlog

MARCH 27, 2024

This episode will help you better prepare for and manage children with inborn errors of metabolism in the Emergency Department. Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEM Currents, the Pediatric Emergency Medicine Podcast. But now I’m going to pass the mic.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

The Skeptics' Guide to EM

DECEMBER 16, 2017

He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. It was a witnessed clonic-tonic seizure that stopped but he did not wake up.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. Personal take: While discussing this approach with many EM physicians whom we respect, one recurring critique was “We fought so hard to get the right to use paralytics in the ED, why would you want to go backwards.” Int J Emerg Med. J Emerg Med. Minimal histamine release.

Emergency Department 66

Emergency Department Soft Tissue Injuries Airway Management Operations 66

Taming the SRU

MAY 1, 2023

EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75 This study showed patients managed safely in the ED with Phenobarbital, and a large portion of these were discharged home.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

EMDocs

JULY 30, 2024

Shortly after this, he began vomiting, and developed a tonic clonic seizure. There was no prodromal illness, recent trauma, polyuria or polydipsia, family history of seizure disorder or diabetes. On arrival to the ED, the patient was agitated, disoriented, tachycardic, and his blood glucose was > 600 mg/dL.

Poisoning 57

Poisoning Seizures Fluid Resuscitation Pediatrics 57

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St. His blood pressure (BP) is 220/120 mmHg.

Stroke 74

Stroke Outcomes EMS Seizures 74

Broome Docs

OCTOBER 31, 2022

PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. Emerg Med J. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. Lancet Neurol.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

Taming the SRU

FEBRUARY 23, 2024

Consider starting more goals of care discussions in the emergency department, not just for patients who are actively dying. Consider alternative pathways that can facilitate a quicker disposition such as utilizing CCTAs for chest pain patients. The intensity of the care plan while inpatient tends to follow that started in the ED.

Pediatrics 73

Pediatrics Ultrasounds Fractures Wellness 73

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. The EM provider asked if the cardiologist thought it was a "STEMI." He was quickly rushed to the CT scanner and a noncontrast head CT was completely normal.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

Taming the SRU

FEBRUARY 22, 2023

Paske et al.

Hospice 40

Hospice EKG/ECG Resuscitation Wellness 40

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent.

Seizures 67

Seizures EKG/ECG Poisoning Shock 67

EMDocs

OCTOBER 5, 2024

We’ll keep it short, while you keep that EM brain sharp. A 62-year-old female patient with a history of recurrent urinary tract infections (UTIs) presents to the emergency department with fever, chills, and dysuria. 12 Complications Inadequate empiric therapy can lead to treatment delays and worse outcomes. doi:10.1001/jama.2018.12163

EMS 75

EMS Infectious Diseases Sepsis Hospitals 75

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure.

Hyperthermia / Hypothermia 69

Hyperthermia / Hypothermia EMS Stroke Seizures 69

EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Unfortunately, seizures in patients with SAH increase the risk of rebleeding.

Seizures 86

Seizures Stroke Outcomes EMS 86

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 63

Documentation/Coding Seizures Psychiatric Wellness 63

Critical Care Now

JUNE 21, 2022

Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director. His coach and fellow players witnessed a seizure-like activity immediately after collapsing. His coach and fellow players witnessed a seizure-like activity immediately after collapsing.

Seizures 52

Seizures EKG/ECG CPR Shock 52

EMDocs

MARCH 11, 2024

Authors: Gaston Omba, MD (EM Resident Physician, Makerere University); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Among children, hypoglycemia is common and can lead to seizures. 34 If patients with cholera are treated quickly and properly, the mortality rate can be reduced to less than 1%.

Dehydration 90

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 90

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. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

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. J Emerg Med. Acad Emerg Med. Ann Emerg Med.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. Forman, H. Yaesoubi, R.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

Taming the SRU

NOVEMBER 18, 2024

This blog post will attempt to serve as a resource to assist in the evaluation of persistent/intractable hiccups and cover the physiology, classification, associated disease processes, evaluation and management strategies of hiccups in the emergency department. He is a graduate from the UC EM residency, class of 2023.

Stroke 80

Stroke Administration COPD Dehydration 80

ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). Figure 1: The EMS rhythm strip. 3-6 Additional features include first-degree atrioventricular block, atrial arrhythmias, nocturnal agonal breathing, and seizures. Click to enlarge.) Figure 2: The initial ECG.

Pediatrics 52

Pediatrics EKG/ECG Documentation/Coding Hospitals 52