Remove Outcomes Remove Seizures Remove Shock
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LAST: Local Anesthetic Systemic toxicity 

Mount Sinai EM

If seizures , treat with usual benzodiazepines. Activate ECMO team early, cardiac arrest due to LAST might be prolonged (especially with bupivacaine) and there’s several case reports with good outcomes after ECMO. Hypoxemia, hypercarbia and acidosis worsen the toxicity. Establish 2 IV access. Patient should already be on a monitor.

Seizures 238
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ToxCard: Iron

EMDocs

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. 1 Obtain a single view abdominal x-ray. 2 L/hr in adults.

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The NICO Trial: NIV in Comatose Patients with Acute Poisoning

RebelEM

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
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The Latest in Critical Care, 1/29/24 (Issue #27)

PulmCCM

three shocks with 2 minutes CPR in between) have been performed. 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
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2023 AHA Update on ACLS

EMDocs

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 2a, LOE B-NR.

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Wide Complex Tachycardia after Ingestion and Seizure

Dr. Smith's ECG Blog

A young man presented after a prolonged seizure. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Approach to Wide Complex Tachycardia Unstable – Shock it 12-lead if at all possible --Unstable defined by : Chest Pain Shock Hypotension Very dyspneic Pulmonary Edema Stable Get a 12-lead ECG Sinus?

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52 in 52 – #41: The CENSER Trial

EMDocs

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, vs 48.4% (OR 3.4,

Sepsis 86