PEMBlog

MARCH 4, 2025

Garcia T, Florin TA, Leonard J, Shah SS, Ruddy RM, Wallihan R, Desai AP, Alter S, El-Assal O, Marzec S, Keaton M, Yun KW, Leber AL, Mejias A, Cohen DM, Ramilo O, Ambroggio L; Childrens Hospitals Initiative for Research in Pneumonia (CHIRP). Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae. Pediatr Emerg Care.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

PEMBlog

SEPTEMBER 13, 2023

Team members and families eagerly await your intervention to halt the seizure and understand its underlying cause. The lack of utility of laboratory testing in children with an unprovoked generalized seizure, or a simple febrile seizure is supported by several observational studies.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

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). We recommend hospitals develop protocols for postarrest temperature control. Seizure prophylaxis in adult survivors of cardiac arrest is not recommended. COR 1, LOE B-NR.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

EMDocs

JANUARY 11, 2024

Methods This scientific statement was led by the AHA and NCS and focused on the acute and critical care management of adult cardiac arrest survivors of in-hospital and out-of-hospital cardiac arrest. EEG Monitoring and Seizures Statements Takeaway: If possible, obtain an EEG to evaluate for seizure activity.

Seizures 98

Seizures Shock Infectious Diseases CPR 98

The Skeptics' Guide to EM

MAY 25, 2024

He has had prior hospital admissions for the management of alcohol withdrawal, including seizures and one prior episode of delirium tremens. Case 1: A patient presents to the ED with nausea, vomiting and some abdominal pain complaining of alcohol withdrawal.

Emergency Department 101

Emergency Department Best Practices Seizures Research 101

Emergency Medicine Ireland

APRIL 29, 2024

Last time i was butchering my way through a diagnostic approach to hyponatraemia, particularly the forms likely to end up in the critical care end of the hospital. They have a seizure on arrival and a Na comes back at 105. A seizure seems fairly easy to define but “coma” is a little bit more vague.

Seizures 75

Seizures Sepsis Stroke Administration 75

EMDocs

AUGUST 28, 2023

A month later the child returns with seizures and altered mental status. A lawsuit is filed against the radiologists, ED physicians and group, the hospital, and the abusing father, who is later convicted of child abuse and sent to prison. Hospital : The doctors are not our employees. We aren’t responsible.

Fractures 92

Fractures Seizures Patient Safety Hospitals 92

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. As may be seen in the table below, there are several themes as well a range of stringency. Find the posterior superior iliac crest and draw an imaginary line across the back (Tuffier’s line) – where this line crosses midline is the L4 spinous process.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Dr. Smith's ECG Blog

DECEMBER 9, 2023

No chest pain, no shortness of breath, no back pain, no numbness, weakness, tingling, no seizures or history of seizures, First ED ECG This still shows apparent inferior OMI. The above said — I thought it may be insightful to review the initial pre-hospital ECG , which has to be interpreted as an acute OMI until proven otherwise.

EKG/ECG 115

EKG/ECG Seizures Wellness EMS 115

Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

Shock 91

Shock Seizures Airway Management Stroke 91

EB Medicine

JUNE 1, 2021

Prevalence, hospitalizations, etc. Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Prevalence, hospitalizations, etc. Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age?

Seizures 52

Seizures Emergency Department EKG/ECG Hospitals 52

Pediatric EM Morsels

AUGUST 18, 2023

Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 91

Stroke EKG/ECG Seizures CPR 91

EMDocs

JUNE 9, 2023

How do we manage the agitated child in the pre-hospital environment? 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. mg/kg IN; 0.1-0.15

EMS 98

EMS Documentation/Coding Pediatrics Psychiatric 98

Mind The Bleep

OCTOBER 29, 2024

First aid done pre-hospital. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. The AMPLE framework offers a structured approach [2]. Type of chemical and strength. Was the patient wearing any protective equipment?

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 94

Sepsis Shock Resuscitation Fluid Resuscitation 94

ALiEM

JUNE 1, 2023

More rigorous studies are needed determine dose thresholds that warrant hospital admission. NMDA Receptors: Role in Ethanol Withdrawal Seizures. Several studies have indicated that dosing with phenobarbital (PO or IV) is safe and effective at decreasing the need for escalating doses of benzodiazepines for EtOH withdrawal [1-6].

Emergency Department 98

Emergency Department Administration Seizures Hospitals 98

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. Will treating with antipyretics prevent a febrile seizure? Critical Care Medicine 2017.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

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 94

Operations Radiology Radiology Fluid Resuscitation 94

Taming the SRU

MARCH 17, 2023

mepivacaine (1-3 h) 1% lidocaine +/- epi (2-3h) 0.25% bupivacaine (2-3 h) 0.25-0.5% mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

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

Emergency Medicine Ireland

MARCH 22, 2021

In Ireland most of it is managed in separate obstetric hospitals by the obstetricians and the anaesthetists. To have eclampsia you simply need to have seizures in addition to the above. The priorities here will be * seizure prevention and treatment. * Any further seizures can be treated with another 2g of magnesium.

Seizures 40

Seizures Wellness Hospitals 40

Mind The Bleep

MAY 16, 2023

Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI. Admission: Low risk patients should not be admitted to hospital for prolonged periods of observation. An event cannot be said to be unexplained unless you have tried to explain it.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. The patient is a 36yo man who was seen for a seizure. Unfortunately, this option might not be available for pre-hospital tracings ( but it can be done once the patient arrives in the ED for their initial hospital tracing ). There was no chest pain.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

The Skeptics' Guide to EM

DECEMBER 7, 2019

Pediatrics 2019 Guest Skeptic: Dr. Katie Noorbakhsh is a pediatric emergency physician at the Children’s Hospital of Pittsburgh. Pediatrics 2019 Guest Skeptic: Dr. Katie Noorbakhsh is a pediatric emergency physician at the Children’s Hospital of Pittsburgh. This will not be a traditional nerdy critical appraisal.

Pediatrics 52

Pediatrics Seizures CPR Hospitals 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. The patient is a 36yo man who was seen for a seizure. Unfortunately, this option might not be available for pre-hospital tracings ( but it can be done once the patient arrives in the ED for their initial hospital tracing ). There was no chest pain.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Vagus nerve stimulation for partial seizures. Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neuroscience and Biobehavioral Reviews. 2005; 29: 493–500. 2015; 4, Art.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

Taming the SRU

FEBRUARY 5, 2024

These patients are often admitted to the hospital. Admission should also be strongly considered in patients with a depressed GCS, post-traumatic seizure(s), or intractable symptoms [2]. In patients with an abnormal CT Head, decisions regarding management and disposition should be made in conjunction with a Neurosurgeon.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

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

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. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Lancet Neurol. 2022 Sep;21(9):781-791.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 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. When consulting nephrology for hyponatremia, please have a urine sodium, potassium, and creatinine at the ready.

Administration 52

Administration Seizures Emergency Department Wellness 52

Mind The Bleep

SEPTEMBER 12, 2023

Severe jaundice causing kernicterus may also cause central hypotonia and seizures. Everything Else Examine the abdomen for any organomegaly which can occur in metabolic or storage disorders or SCORTCH infections Look for signs of jaundice which can occur with hypothyroidism or inborn errors or metabolism.

Sepsis 52

Sepsis Seizures Poisoning Wellness 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. American Heart Association/American Stroke Association. 2022 Jul;53(7):e282-e361. PMID: 35579034.

Stroke 101

Stroke Outcomes EMS Seizures 101

Dr. Smith's ECG Blog

DECEMBER 26, 2020

His friend was able to get him into the truck and drive him to a nearby community hospital (non-PCI center). Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 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. This list is not exhaustive, and, as always, if you are unsure about anything, you should always escalate.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

PEMBlog

SEPTEMBER 6, 2023

Life threatening non-psychiatric causes of acute psychosis include hypoglycemia, cerebral hypoxia, drug toxicity, CNS abnormalities (such as brain tumor, meningoencephalitis, injury, seizures, or stroke), metabolic conditions, electrolyte disturbances, hepatic failure, uremia, or thyrotoxicosis.

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52