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

The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Guest Skeptic: Jesse Spurr works as a Nurse Educator in the Emergency Department at Redcliffe Hospital in Australia. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the Emergency Department at Redcliffe Hospital in Australia. The nurse triages both to beds in the acute/resuscitation area of the department.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Broome Docs

OCTOBER 31, 2022

Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Lancet Neurol. 2022 Sep;21(9):781-791. 2018 Sep 11;362:k3843.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

EMDocs

JANUARY 29, 2024

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. Neurosurgery takes the patient to surgery after the CT angiogram suggests aneurysmal rupture.

Stroke 98

Stroke Outcomes EMS Seizures 98

Mind The Bleep

SEPTEMBER 12, 2023

Did the baby need resuscitating? Severe jaundice causing kernicterus may also cause central hypotonia and seizures. What were the APGAR signs? If so, were they intubated and admitted to NICU? Were they cooled? Were the cord gases poor?

Sepsis 52

Sepsis Seizures Poisoning Wellness 52

Mind The Bleep

DECEMBER 31, 2023

Hello, this is Dr so-and-so, renal SHO on call’ Depending on your hospital renal facilities, you are likely to only hold the renal bleep in F2 or above. Ask your renal team if the hospital has a subscription. Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Pediatric Emergency Playbook

APRIL 1, 2016

S – seizure or shock – most commonly septic, but can be any type: cardiogenic, bstructive, hypovolemic, distributive. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. Difficult to interpret lactates when a patient is on an epinephrine drip. Mayo Clin Proc.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

PulmCCM

JANUARY 29, 2024

automated external cooling system) for all arrest patients (with any presenting rhythm, occurring in- or out-of-hospital) maintained for at least 24 hours; longer periods of fever prevention (which AHA now calls “temperature control”) for persistently comatose patients are also considered reasonable.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

EMDocs

JUNE 22, 2024

Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here. If AFE occurs during labor, immediate delivery is recommended.

EMS 111

EMS Resuscitation Seizures Blood Transfusions 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. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

EMDocs

MAY 15, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. COVID-19 and ACS COVID increases the risk of hospitalization, pneumonia, pain, and ACS in SCD patients. pneumoniae, C.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. COVID-19 and ACS COVID increases the risk of hospitalization, pneumonia, pain, and ACS in SCD patients. pneumoniae, C.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

EMDocs

OCTOBER 5, 2024

They are found primarily in hospital specimens but are increasing in frequency in samples from the community. Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV). IV fluid resuscitation as needed.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Taming the SRU

MARCH 30, 2024

Emergency Critical Care Center (EC3) at the University of Michigan: Dedicated critical care unit within the emergency department that was created to improve access to timely, high-quality critical care after identifying a gap in emergency care delivery for patients Reduced risk-adjusted 30 day mortality among all ED patients, lower ICU admission rates (..)

Hyperthermia / Hypothermia 96

Hyperthermia / Hypothermia Leadership Emergency Department Seizures 96

Don't Forget the Bubbles

AUGUST 12, 2024

After a traumatic brain injury, all children and young people should have a C-ABCDE rapid assessment for life-threatening injuries (as per ATLS guidelines) focussed on trauma resuscitation and stabilisation, followed by a secondary assessment. Do we need seizure prophylaxis?

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

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. Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion.

Poisoning 74

Poisoning Seizures Fluid Resuscitation Pediatrics 74

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). 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. 11) A bolus dose at 1.5

Poisoning 88

Poisoning Seizures Pediatrics EMS 88

Mind The Bleep

OCTOBER 17, 2024

Clinically, your enthusiasm for providing maximal quality care needs balanced against rescue practicalities and a hostile environment (very different to your warm, dry resuscitation bay) – the cold makes all veins disappear…and you may be the only clinician responder at the scene. What illnesses or injuries do we see?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Sensible Medicine

JUNE 30, 2023

Patients present with troublesome symptoms that they “just want checked out before the weekend” and I’m left either worrying about them all weekend or admitting them to the hospital where I know little will happen for the next two days. She did not require hospitalization. It was not exertional.

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

Don't Forget the Bubbles

MARCH 18, 2024

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). A similar process can also occur in the CNS (causing seizures ), the liver and the pancreas. What causes haematuria in children?

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Downeast Emergency Medicine

APRIL 26, 2021

We know that if administered too rapidly, it can lead to hypotension and other adverse effects including seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired color vision, and other visual disturbances.[1] Lastly, the use of TXA is not without risk.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

FEBRUARY 22, 2023

STEP-UP Self Physical and Psycological IM-SAFE Illness Medications Stress Alcohol Fatigue Eating Psychological Cognitive Threat/Challenge appraisal: PERCEIVED demands vs. resources Threat appraisal - stress levels excessive, performance impaired – vapor lock (autonomic arousal, tunnel vision, auditory exclusion, loss of time awareness, impaired memory (..)

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

Critical Care Now

JUNE 21, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. His coach and fellow players witnessed a seizure-like activity immediately after collapsing. En route to the hospital, the patient began to move all of his extremities and responded to painful stimuli.

Seizures 52

Seizures EKG/ECG CPR Shock 52

PulmCCM

JANUARY 20, 2025

New guidelines on cardiopulmonary resuscitation in adults were published in Circulation in November 2024. The International Liaison Committee on Resuscitation (ILCOR) is comprised of experts on resuscitation around the world. Hospitals not using backboards were not encouraged to start. They’re 187 pages long.

CPR 75

CPR Resuscitation Hyperthermia / Hypothermia Seizures 75

Pediatric Education

NOVEMBER 10, 2024

At the outside hospital and in the NICU there were communication problems and the parents both emphasized the mother’s doctor told them it was important to let the baby’s doctors know about some issue to do with cats. What are the basic first steps for newborn resuscitation?

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Resuscitation 40

Pediatric EM Morsels

MARCH 7, 2025

Military Application of Tranexamic Acid in TraumaEmergency Resuscitation (MATTERs) Study. Tranexamic Acid Use in United States Children’s Hospitals. of IV form TXA [O’Neill 2020] Inexpensive ! 2011 Mar26;377(9771):1096-101, 1101.e1-2. PubMed: 21439633] Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Crit Care Explor.

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

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. 7 May lead to respiratory failure.

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

Taming the SRU

FEBRUARY 3, 2025

These can lead to a wide spectrum of emergent complications including but not limited to cardiac dysrhythmias, seizures, and acute renal failure. This can often become significant enough to precipitate dysrhythmias, seizures, and tetany (20). in females and 2.5-7.0 in males) phosphate > 4.5 mg/dl (adults) and > 6.5

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Don't Forget the Bubbles

OCTOBER 9, 2023

Staff, patients, and relatives can all be affected in the hospital setting, especially in life-or-death situations. Does incivility exist in hospitals? This mixed-method study surveyed 606 trainees and consultants from three large teaching hospitals. A 13-year-old girl came to the ED with an unprecedented, prolonged seizure.

Seizures 116

Seizures Incident Reporting Emergency Department Research 116

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, HAJDU Mild TBI’s & Concussions in the Emergency Department TBI’s are relatively common >3 million TBI’s in the US annually 2.5

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

Taming the SRU

NOVEMBER 13, 2024

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 mg/kg (of 0.1 2x maintenance rate

Psychiatric 90

Psychiatric Seizures Emergency Department Pediatrics 90

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. 8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated.

Poisoning 91

Poisoning Fluid Resuscitation Administration Seizures 91

ACEP Now

OCTOBER 29, 2024

He underwent placement of a dual chamber, implantable, cardioverter-defibrillator (ICD) placement on hospital day 5. 3-6 Additional features include first-degree atrioventricular block, atrial arrhythmias, nocturnal agonal breathing, and seizures. 7 The ECG findings can be concealed or transient after resuscitation from cardiac arrest.

Pediatrics 52

Pediatrics EKG/ECG Documentation/Coding Hospitals 52