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 Outcomes Pediatrics 145

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States.

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

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

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 Study included children, as well as adults.

Seizures 64

Seizures Administration Anaphylaxis Outcomes 64

Dr. Smith's ECG Blog

DECEMBER 9, 2023

Inferior Aneurysm morphology is incredibly hard to differentiate from Acute OMI, but you should suspect it whenever there are well-formed inferior Q-waves. 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.

EKG/ECG 103

EKG/ECG Seizures Wellness EMS 103

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. 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.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

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. Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. AtherlyJohn et al. A systematic review by Freedman et al.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

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

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. 6 Seizures have been observed and are dose-dependent.

Poisoning 90

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 90

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 108

EKG/ECG Seizures Hospitals Stroke 108

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 75

Seizures Shock Infectious Diseases CPR 75

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

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 80

Hospitals Hospice Resuscitation COPD 80

ALiEM

JUNE 1, 2023

Well not exactly. More rigorous studies are needed determine dose thresholds that warrant hospital admission. NMDA Receptors: Role in Ethanol Withdrawal Seizures. Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? 2012.07.056.

Administration 98

Administration Emergency Department 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

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. There were some ACEP business decisions at the April Board meeting, as well. 17-23, 2025 in Orlando, Florida.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Mind The Bleep

OCTOBER 17, 2024

Your skills as a doctor need to be different to your hospital role or abilities. Seizures, chest pain, intoxication, and deliberate self-harm were also reported. Other treatments are available for nausea, respiratory depression, cardiac pain, seizures, hypoglycaemia, and asthma. What illnesses or injuries do we see?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Mind The Bleep

MAY 16, 2023

It also requires exclusion; even though the child in front of you appears well they still need a thorough history and examination to make sure there isn’t something more concerning going on. Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

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 EMS 98

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 76

Poisoning Fluid Resuscitation Seizures Resuscitation 76

Emergency Medicine Ireland

MARCH 22, 2021

In Ireland most of it is managed in separate obstetric hospitals by the obstetricians and the anaesthetists. Unfortunately its rarity does not get us out of having to know it very well as it is an exam favourite. To have eclampsia you simply need to have seizures in addition to the above. Firstly some definitions.

Seizures 40

Seizures Wellness Hospitals 40

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. This has been trialled (out of hospital) in known children with SVT.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

EMDocs

JUNE 14, 2023

This leads to an enhanced, as well as a prolonged predominant cholinergic effect. Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. Farmers treating sheep for parasites may be symptomatic after exposure, an illness called Dipper’s Flu. 1 Avoid cholinergic agents that will exacerbate symptoms.

PPE 70

PPE Poisoning Seizures Emergency Department 70

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

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 67

Operations Radiology Radiology Fluid Resuscitation 67

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. After a several week NICU stay for prematurity, the infant has been generally healthy and this is his first trip back to the hospital since discharge. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 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

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. Her name is Emily Groopman, and she’s a current resident at Children’s National Hospital. So they’re lethargic, they might vomit, they’re hypotonic, hypothermic, they might have fever or seizures. Brad’s not a pediatric medical geneticist. No, I’m not.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. There were no injuries and no chest pain and he appeared well. The patient is a 36yo man who was seen for a seizure. This was sent to me by Jason Winter, of Facebook Clinical Electrocardiology Page [link] This is a 36 yo m with h/o TBI and epilepsy.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. He is apyrexial. How would you treat priapism?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. There were no injuries and no chest pain and he appeared well. The patient is a 36yo man who was seen for a seizure. I'm highlighting it again, with comments from Ken Grauer below. This was sent to me by Jason Winter. There was no chest pain.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Taming the SRU

MAY 1, 2023

Trauma/Pre-Hosp Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension Link: [link] Bottom Line: Think about maintaining normotension rather than simply avoiding hypotension in isolated TBI. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

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

Taming the SRU

SEPTEMBER 1, 2023

Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

Northwestern EM Blog

JANUARY 10, 2022

For those well-appearing neurologically intact hyponatremia patients w/ sodium levels > 120, further work-up & analysis of the underlying etiology can be deferred to the inpatient side. Hypertonic saline is not only indicated for seizures, coma, suspected cerebral herniation or focal neurological deficits as noted above.

Administration 52

Administration Seizures Emergency Department Wellness 52

ACEP Now

APRIL 2, 2024

1 In severe cases altered mental status, seizures, coma, or even death have been observed. Under their recommendation, the patient was admitted to the hospital for observation on an intravenous dextrose infusion. Dr. Franco is an emergency medicine attending physician at St. References Katibi OS, Olaosebikan R, et al.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40