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

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients.

Poisoning 139

Poisoning Airway Management Seizures Shock 139

The Skeptics' Guide to EM

DECEMBER 15, 2018

Acetaminophen and febrile seizure recurrences during the same fever episode. He specialises in Paediatric Emergency Medicine and is a passionate […] The post SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen? Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics.

Seizures 52

Seizures Pediatrics Emergency Department Administration 52

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.” Plaintiff : You never acknowledged the alleged “7 minute” seizure.

Seizures 101

Seizures Dehydration Documentation/Coding Infectious Diseases 101

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

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

PulmCCM

JANUARY 29, 2024

EEG Advised, to Rule Out Nonconvulsive Seizures Nonconvulsive seizures are occasionally present in comatose patients after cardiac arrest, undetectable without testing. Seizure prophylaxis was advised against, as there is no evidence for its efficacy.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

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

Dr. Smith's ECG Blog

MARCH 11, 2012

A young man presented after a prolonged seizure. Outcome: the patient recovered uneventfully. He had had a fight with his girlfriend, and she thinks he ingested something, thinks it was ecstasy (MDMA) but might have been other things. The patient was unconscious. He was intubated. K was normal. Blood pressure was 180/80.

Seizures 52

Seizures Shock EKG/ECG Outcomes 52

EMDocs

JANUARY 8, 2024

Magnesium does not improve ROSC, survival, or neurologic outcomes, no matter the presenting rhythm (Level 3: no benefit). Avoid routine seizure prophylaxis in adult survivors of cardiac arrest (Level 3: no benefit), but treat seizures if they occur (Level 1: strong). o C recommended (Level 1: strong). COR 1, LOE C-LD.

Seizures 97

Seizures Shock CPR Hyperthermia / Hypothermia 97

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. EEG Monitoring and Seizures Statements Takeaway: If possible, obtain an EEG to evaluate for seizure activity.

Seizures 94

Seizures Shock Infectious Diseases CPR 94

Pediatric EM Morsels

AUGUST 9, 2024

If not treated early, then increased risk of poor outcomes and death. Maternal screening early in pregnancy is the best means to prevent congenital syphilis. Penicillin is 98% effective at preventing congenital syphilis. Hussain, 2023 ] Excellent prognosis if treated early.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

Don't Forget the Bubbles

OCTOBER 23, 2023

They may also already have other seizure types and be under paediatric services. Maintenance therapy is sometimes required in patients with higher seizure risks. Outcomes are extremely variable, dependent on the cause, and include developmental delays, neurodivergence, or behavioural issues. How are Infantile Spasms diagnosed?

Seizures 75

Seizures Outcomes Wellness 75

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, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

Dr. Smith's ECG Blog

MAY 8, 2014

In 49 patients with known TCA overdose , a maximum limb lead QRS duration greater than 100 ms was 100% sensitive for detecting patients who will seize, and seizure is a harbinger of cardiovascular collapse. Of 14 with initial QRS of 140 ms or longer, 8 (56%) had seizures. Sodium channel blockade in the CNS leads to seizures.

Seizures 52

Seizures EKG/ECG Administration EMS 52

Don't Forget the Bubbles

NOVEMBER 29, 2024

Neurological Effects : Headache, dizziness, seizures, or coma due to cerebral oedema. Predictors of Mortality The prognosis of methanol poisoning depends on several factors, with certain clinical and biochemical markers strongly associated with poorer outcomes. Permanent blindness is a significant risk without treatment.

Poisoning 64

Poisoning Forensics Seizures Outcomes 64

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

Dr. Smith's ECG Blog

MARCH 30, 2014

They were worried that the syncope was seizure and that she had brain mets. Outcome and Analysis: ECG 1 is diagnostic of inferior and right ventricular MI. Previous ECG. The lactate was elevated and pH low. Then they were worried about sepsis as an etiology of hypotension. Troponin was repeated and returned higher still.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

Mind The Bleep

OCTOBER 29, 2024

These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes.

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

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. Lowering the MAP may mitigate these risks and possibly improve outcomes.

Stroke 91

Stroke Outcomes EMS Seizures 91

The Skeptics' Guide to EM

DECEMBER 16, 2017

Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. It was a witnessed clonic-tonic seizure that stopped but he did not wake up. The paramedics report another seizure on route to the hospital. He then has another seizure in the department. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

Taming the SRU

JUNE 26, 2023

morbidity and mortality - wellness: behind the curtain Morbidity and mortality WITH dr. zalesky Meningitis Meningitis is an extremely difficult diagnosis with almost no clinical findings that can aid in the diagnosis outside of suspicion and a LP Seizures can be a presenting sign of infections, often without fevers or leukocytosis Of patients with (..)

Seizures 52

Seizures Best Practices Wellness Outcomes 52

Ziqitza HealthCare Ltd

JUNE 13, 2024

Knowledge of life-saving skills can significantly impact patient outcomes, potentially saving lives and avoiding future health complications. Rapid medical response is essential in this case to prevent long-term complications and death and improve outcomes. Perform the heimlich maneuver if the patient is choking.

Burns 52

Burns Stroke Ambulance Services Dehydration 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Definition of status epilepticus:Continuous seizure activity of 5 minutes or greater – OR – Recurrent activity without recovery between intervals. This definition includes clinically apparent seizures as well as those seen only on EEG.) During a seizure, GABA receptors in the neuron’s membrane are internalized and destroyed.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

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

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

Don't Forget the Bubbles

MARCH 18, 2024

A similar process can also occur in the CNS (causing seizures ), the liver and the pancreas. Depending on the progression of the illness, children may present with pallor, oedema, lethargy, seizures, hypertension or abnormal liver function tests. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. F1000Research.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

EMDocs

MAY 15, 2024

Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. High risk and low prevalence diseases: Acute chest syndrome in sickle cell disease.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. What was the outcome? Outcome "I later found out that this is a patient who regularly calls paramedics to c/o chest pains and he had fooled many of them. The patient is a 36yo man who was seen for a seizure. This also argues against STEMI.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Taming the SRU

MARCH 14, 2023

Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. The seizure abated with rectal diazepam given by the squad. You notice a med-alert bracelet with the patient’s name and the word “SEIZURES.” His abdomen is soft. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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. There was a good outcome. Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central synapses, but is also a local anesthetic (-caine!)

Seizures 52

Seizures Administration Outcomes 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. What was the outcome? Outcome "I later found out that this is a patient who regularly calls paramedics to c/o chest pains and he had fooled many of them. The patient is a 36yo man who was seen for a seizure. This was posted a few years ago.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Vagus nerve stimulation for partial seizures. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neuroscience and Biobehavioral Reviews. 2005; 29: 493–500.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52