The Skeptics' Guide to EM

DECEMBER 16, 2017

Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Case: Johnny is a […] The post SGEM#199: Therapeutic Hypothermia – What is it Good For? Hypothermia for Neuroprotection in Convulsive Status Epilepticus. 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

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

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). Patients with spontaneous hypothermia after ROSC unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5° COR 2b, LOE C-LD. C per hour.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

Pediatric EM Morsels

AUGUST 9, 2024

We have previously discussed hypothermia presentations , GBS infections , and HSV infections. Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Obviously, one of the most concerning considerations in neonates is the potential for infection.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

Taming the SRU

MARCH 30, 2024

Predictions scores such as the HOPE score can be used to guide treatment.

Hyperthermia / Hypothermia 95

Hyperthermia / Hypothermia Leadership Emergency Department Seizures 95

Mind The Bleep

OCTOBER 29, 2024

Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

Other considerations in significant TBI would be the temporary use of anti-epileptic drugs as prophylaxis to prevent early post-traumatic seizures to aid neuroprotection; the most commonly used would be levetiracetam. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Dr. Smith's ECG Blog

JULY 14, 2010

Before EMS arrived, she had "seizure activity" and became unresponsive. She underwent therapeutic hypothermia, and emerged from coma. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She was intubated. She awoke and was discharged to home with no disability

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 52

Don't Forget the Bubbles

AUGUST 12, 2024

There is weak evidence to suggest that moderate hypothermia (32-33 o C) can be used for ICP control in specialist settings. Do we need seizure prophylaxis? Children and young people have lower seizure thresholds than adults. Either levetiracetam or phenytoin can be used for seizure prophylaxis.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Pediatric Education

APRIL 30, 2023

The past medical history showed she was a 38 week infant who had neonatal seizures that were easily controlled. She was weaned off antiepileptics after not having additional seizures several months later. Treatment may include anti-epileptics, antibiotics, therapeutic hypothermia, and other interventions.

Stroke 52

Stroke Seizures Pediatrics Hyperthermia / Hypothermia 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. 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

EMDocs

MAY 28, 2024

Hypothermia, hypotension, and vasoconstriction may affect pulse oximetry reading, which is based on light absorption from fingertip blood flow. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Pulse oximetry is also based on HbA, not HbS.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Pediatric Education

MAY 7, 2023

Malignant hyperthermia is associated with inhaled anesthetics and some muscle relaxants and occurs usually very suddenly within minutes to hours. Resolution is also longer (9 or so days). Anticholinergic toxicity occurs with taking an anticholinergic agent usually within 1-2 hours with resolution within hours to days.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Infectious Diseases Pediatrics Poisoning 40

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. 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

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 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. The GCS must be obtained through interaction with the patient (i.e.,

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Mind The Bleep

OCTOBER 17, 2024

Of the medical conditions reported, hypothermia was the largest group – the vast majority mild. 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.

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Taming the SRU

APRIL 17, 2023

Patients typically present with tachycardia, mydriasis hyperthermia, altered mental status, anhidrosis, and urinary retention. Severe cases may result in seizures or coma. These atropine-like alkaloids produce an anticholinergic syndrome when smoked or ingested.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Drowsy (11.97%), Hypothermia (13.04%) and Cyanosis (10%) were also high risk categories. SEIZURE (FIT) 715 16 250 35 2.24[1.4 0[0 , 12] HYPOTHERMIA 23 3 11 47.8 Results and Conclusion Data was collected from 84,999 patients, of which 1,159 people died within 30 days of attendance. 0.12 , 0.33] CHEST PAIN 5953 34 2077 34.9

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

EMDocs

DECEMBER 16, 2023

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. A 12-lead EKG shows sinus tachycardia but is otherwise normal. 1 Fever is usually < 40C. 1 Fever is usually < 40C.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

ALiEM

MARCH 5, 2024

With severe toxicity, patients can have altered mental status, seizures, hyperthermia, and pulmonary edema. Salicylate has a direct effect on the respiratory center of the medulla causing tachypnea. Tinnitus, nausea, vomiting, and abdominal pain are common.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Hyperkalemia 2. Other drugs with sodium channel blockade: Tricyclic antidepressants. Other sodium channel blockers, such as flecainide.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. EMS reported an initial GCS of 8 with pupils equal and reactive.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

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 64

Documentation/Coding Seizures Psychiatric Wellness 64

Taming the SRU

JANUARY 5, 2025

Potential complications include dysrhythmias, respiratory failure, DIC, seizures, and hepatic failure. Specificity: 90.7%) Exposure to a dopamine antagonist or withdrawal of a dopamine agonist in the prior 72 hours: 20 points Hyperthermia (>100.4 Workup for complications should be initiated on a case by case basis.

Hyperthermia / Hypothermia 97

Hyperthermia / Hypothermia Dehydration Psychiatric Poisoning 97

PulmCCM

JANUARY 20, 2025

° = OK In 2022, ILCOR and the AHA acknowledged the lack of evidence supporting hypothermia after cardiac arrest: the original studies were never convincingly replicated, and the largest randomized trials suggested no benefits from cooling patients below 37.5° Seizure Prophylaxis and Treatment of Abnormal EEGs Read more

CPR 75

CPR Resuscitation Hyperthermia / Hypothermia Seizures 75

EMDocs

JANUARY 6, 2025

She presents with a seven-day history of fever, fatigue, and myalgias associated with decreased oral intake and an episode of seizure-like activity three hours prior to arrival. Additionally, there is no family history of seizure disorders. A review of systems is notable for nausea and vomiting but no diarrhea.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75