Taming the SRU

DECEMBER 17, 2024

compared the effects of these two among the acute gastroenteritis children and reported that the use of ORT was associated with shorter hospital stay and increased patient satisfaction. demonstrated that use of ORT was characterized by shorter stays at the hospital. AtherlyJohn et al. A systematic review by Freedman et al.

Dehydration 84

Dehydration Fluid Resuscitation Administration Resuscitation 84

ACEP Now

JULY 7, 2024

35-year-old man presents by EMS with seizures. According to family at the scene, he has a history of seizures but has not been taking his medication recently. On arrival, he is obtunded, foaming at the mouth, and exhibiting generalized tonic-clonic seizure activity. Clinical Question » How should status epilepticus be diagnosed?

Seizures 52

Seizures Emergency Department Outcomes 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 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

RebelEM

FEBRUARY 15, 2024

PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation?

Poisoning 139

Poisoning Airway Management Seizures Shock 139

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

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

Don't Forget the Bubbles

JANUARY 24, 2024

Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management. What causes Super Refractory Status Epilepticus?

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Northwestern EM Blog

JULY 22, 2024

PRES can quickly devolve from a throbbing, atypical headache to seizures and brain hemorrhage, so intervening as soon as possible with aggressive BP reduction is the goal. Seizure management follows generally conventional practices. Adjunctive magnesium infusions are indicated for pregnant and postpartum cases. Tandlich, M.

Seizures 97

Seizures Documentation/Coding Hospitals 97

EMDocs

MAY 9, 2024

The triage nurse records the event as a “seizure” lasting 7 minutes. His MDM says nothing about the patient’s seizure but does state that “there is an ongoing community outbreak of gastroenteritis… and 6 patients currently in the ED with similar sx.” The word “seizure” should capture one’s attention.

Seizures 101

Seizures Dehydration Documentation/Coding Infectious Diseases 101

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

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 81

Seizures Administration Anaphylaxis Outcomes 81

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 97

Seizures Shock CPR Hyperthermia / Hypothermia 97

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 94

Seizures Shock Infectious Diseases CPR 94

Don't Forget the Bubbles

JUNE 30, 2023

And hot off the press… the international PATCH ( P rehospital A ntifibrinolytics to T rauma C oagulopathy and H aemorrhage) study (just published on 14th June 2023) compared a prehospital TXA bolus, followed by an eight-hour infusion with placebo in more than 1300 adult patients from 21 hospitals across three countries. in the placebo group).

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Dr. Smith's ECG Blog

OCTOBER 25, 2023

The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation.

EKG/ECG 125

EKG/ECG Seizures Hospitals Stroke 125

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 95

Emergency Department Best Practices Seizures Research 95

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

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 110

EMS Resuscitation Blood Transfusions Seizures 110

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 95

Hyperthermia / Hypothermia Emergency Department Leadership Seizures 95

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

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. He reports no personal or familial history of seizures. The physicians quickly recognized that this was not a seizure and likely cardiac in nature.

Seizures 40

Seizures EKG/ECG Shock EMS 40

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 116

EKG/ECG Seizures Wellness EMS 116

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

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 82

Fractures Seizures Patient Safety Hospitals 82

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

JANUARY 17, 2024

Neurologic symptoms: Encephalopathy, seizures, or coma (5,7) Cardiovascular symptoms: Hypotension, conduction disturbances, ventricular tachycardia or fibrillation, pulseless electrical activity, or asystole (10) Breaking, crushing, or chewing the capsules can produce numbness, choking, bronchospasm or laryngospasm. (5)

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

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

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 Hyperthermia / Hypothermia 52

ALiEM

OCTOBER 4, 2023

1, 5] Muscarinic symptoms (Common acronyms SLUDGE or DUMBBELLS) Salivation, emesis, diarrhea, and lacrimation Miosis Seizures Bradycardia, bronchospasm, and bronchorrhea are usually the cause of death. Give 600 mg IM every 5 min prehospital or 1-2 g loading dose IV in hospital with optional repeat bolus after 1 hour or continuous infusion.

Poisoning 78

Poisoning Seizures Hospitals 78

Don't Forget the Bubbles

AUGUST 12, 2024

Do we need seizure prophylaxis? Children and young people have lower seizure thresholds than adults. Following TBI, seizures are common and may be missed in children and young people who are sedated and paralysed. Either levetiracetam or phenytoin can be used for seizure prophylaxis.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

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 95

EMS Documentation/Coding Pediatrics Psychiatric 95

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

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

Don't Forget the Bubbles

NOVEMBER 29, 2024

Neurological Effects : Headache, dizziness, seizures, or coma due to cerebral oedema. Patients who are already unconscious when they arrive at hospital are at significantly greater risk of death. This selective toxicity is caused by the disruption of mitochondrial function in retinal cells. Severe acidosis (pH <7.0)

Poisoning 64

Poisoning Forensics Seizures Outcomes 64