Emergency Medicine Cases

JULY 8, 2024

In this episode: recognition, risk stratification, decision tools, indications for lumbar puncture in the febrile pediatric patient, tips and trick on performing LPs in children, and ED management of pediatric meningitis. and many more.

Pediatrics 101

Pediatrics EMS Wellness Seizures 101

Pediatric EM Morsels

AUGUST 23, 2024

The post Return to Learn / Return to Sport after Concussion appeared first on Pediatric EM Morsels. Br J Sports Med. 2023 Jun;57(11):695-711. doi: 10.1136/bjsports-2023-106898. PMID: 37316210.

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Seizures Pediatrics Academics Emergency Department 270

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?

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Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Don't Forget the Bubbles

JANUARY 29, 2024

A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Despite this, the CFAM still showed ongoing electrical seizure activity.

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Seizures Pediatrics Research Wellness 122

PEMBlog

SEPTEMBER 15, 2023

Did you know that lab tests and CT scans are not recommended for most children who fully recover after a simple febrile seizure or a first-time, unprovoked generalized seizure? This video features Dr. Archit Sahai who conducts a simulated discussion with a parent of a child following a seizure.

Seizures 52

Seizures Pediatrics 52

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

The Skeptics' Guide to EM

DECEMBER 15, 2018

Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics. 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.

Seizures 52

Seizures Pediatrics Emergency Department Outcomes 52

Pediatric EM Morsels

DECEMBER 20, 2024

Joint pain Hemolytic anemia due to the presence of IgM antibodies on RBCs causing autoimmune hemolysis Rarely neurological complications such as meningoencephalitis, seizures , transverse myelitis , GBS , and cerebellar ataxia. The post Mycoplasma Pneumonia in Children appeared first on Pediatric EM Morsels. UpToDate , 1 Nov.

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CDC Seizures Pediatrics EMS 130

JournalFeed

APRIL 24, 2021

We cover leadership through change, IN midazolam for pediatric seizure, hypothermia and young infant sepsis risk, VICTAS RCT, and clinically diagnosing GHB intoxication. It’s the JournalFeed Podcast for the week of Apr 19-23, 2021.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures Sepsis Leadership 52

Pediatric EM Morsels

OCTOBER 6, 2023

Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. In the US 95% of vaccine-eligible pediatric patients who travel are unvaccinated (McAteer 2021) Drug resistance has been developing over time. In addition to my passion for PEM, I also share a passion for global health.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

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

JournalFeed

DECEMBER 11, 2021

We cover patient-centered diagnostic excellence, alteplase before endovascular stroke treatment, steroids for pediatric retropharyngeal abscess, LP for febrile seizure, and the new AHA chest pain guideline. It’s the JournalFeed Podcast for the week of December 6-10, 2021.

Seizures 52

Seizures Stroke Pediatrics 52

Don't Forget the Bubbles

JUNE 30, 2023

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. There was a small increased risk of seizures in the TXA group – 0.3% (7 children) of the 1900 children in the TXA group vs none of the 1900 children in the non-TXA group. Pediatr Crit Care Med. But that’s not where it ends.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Pediatric EM Morsels

AUGUST 18, 2023

Jackson 2016) A systematic review of safety data for over 16000 pediatric patients did show MAEs were the most frequently reported event. 451 pediatric patients were included. From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%. Pediatrics.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

PEMBlog

AUGUST 28, 2023

Staring this week, and continuing for the next five, we will be releasing new content supporting the key Pediatric Emergency Medicine recommendations of Choosing Wisely. Do not obtain screening laboratory tests in the medical clearance process of pediatric patients who require inpatient psychiatric admission unless clinically indicated.

Pediatrics 52

Pediatrics Seizures Psychiatric 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Get up-to-date in the understanding and management of pediatric status epilepticus. 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.)

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Don't Forget the Bubbles

NOVEMBER 11, 2024

Therapeutic hypothermia is thought to decrease the brain’s metabolic demand, reduce inflammation and cell death, and reduce the risk of seizures. Pediatr Crit Care Med. Targeted Temperature Management in Pediatric Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis. What do the guidelines recommend?

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

Pediatric EM Morsels

AUGUST 9, 2024

The post Congenital Syphilis appeared first on Pediatric EM Morsels. Pemphigus syphiliticus Hepatomegaly Most common May have abnormal LFTs and evidence of Hepatitis. Jaundice Lymphadenopathy Generalized Epitrochlear lymphadenopathy is suggestive of congenital syphilis. A case of congenital syphilis. Emerg Radiol. 2013 Aug;20(4):337-9.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Pediatric EM Morsels

APRIL 7, 2023

There are many conditions that we would like to think belong only to the “ adult patient problem DDx; ” however, as we have discussed several times previously, pediatric patients can experience many “adult conditions” (see, Aortic Dissection , Kidney Stones , and Cholecystitis ). Expert Rev Hematol. doi: 10.1586/ehm.13.25.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

EMDocs

MARCH 2, 2024

 An Pediatr (Engl Ed). 2019 Seizure as Early Presentation of a Pneumocephalus after Cochlear Implant: A Case Report. J The most common causes include trauma and cranial surgeries, but there are other etiological factors, and in rare cases, it can also be spontaneous. [1-3] Int J Crit Illn Inj Sci. 2017  2017 Jan-Mar;7(1):58-64.

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EMS Fractures Seizures Head Injuries 114

EMDocs

JANUARY 17, 2024

5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) 9) In 2019, benzonatate accounted for ~ 10% of all pediatric antitussive prescriptions dispensed via retail pharmacies. (9) 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) Benzodiazepines are first-line therapy for seizures.

Poisoning 67

Poisoning Seizures Pediatrics EMS 67

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. Pediatr Crit Care Med.

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Seizures Pediatrics Emergency Department Ambulance Services 75

EMDocs

DECEMBER 6, 2024

Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Ferrous sulfate tablets are radiopaque and can be visualized on radiographs, however not all preparations are radiopaque (pediatric chewable and liquid preparations). McGraw Hill; 2019.

Poisoning 76

Poisoning Fluid Resuscitation Seizures Resuscitation 76

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. How is pediatric stroke different than perinatal stroke? Otherwise she was described as a normally developing child.

Stroke 52

Stroke Seizures Pediatrics Hyperthermia / Hypothermia 52

EMDocs

NOVEMBER 6, 2023

Flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias. We recommend the use of benzodiazepines to treat seizures associated with local anesthetic systemic toxicity. Editorial Comment: Give atropine, benzo’s for seizures. COR No Benefit, LOE C-EO.

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Poisoning Hyperthermia / Hypothermia Seizures Administration 94

Taming the SRU

JANUARY 12, 2024

pediatric small groups WITH our cchmc colleagues Dermatologic emergencies Children can present with a wide range of rashes, many of which are benign, however identifying concerning rashes is very important. Use your resources to differentiate scary from benign! Children are not just small adults!

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 6 Seizures have been observed and are dose-dependent. 1 Benzodiazepines are preferred as the first line of treatment for agitation or seizures. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report.

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Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 90

EMDocs

JUNE 7, 2023

mg/kg pediatrics) Double dose every 5 min Titrate up to end point of therapy and may require very large doses Target End Point of Therapy = clear chest sounds, HR > 80/min, pupil size greater than pinpoint, and dry axillae. Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. See figure below.

Poisoning 84

Poisoning Airway Management Seizures PPE 84

The Skeptics' Guide to EM

NOVEMBER 18, 2017

We have covered fever before on the SGEM in pediatric patients. There was the great episode on pediatric fever fear with PedEM Super Hero Anthony Crocco ( SGEM#95 ). We also did a RANThony on pediatric fever fear that you can watch on YouTube. Will treating with antipyretics prevent a febrile seizure?

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

ALiEM

NOVEMBER 15, 2023

1,6,7] Dizziness, confusion, headache Shortness of breath Weakness and malaise Nausea and vomiting Hypotension, seizures, coma, apnea, arrhythmias Death due to cardiorespiratory arrest How do you diagnose cyanide poisoning? [7] Dosing for 3% sodium nitrite solution [8]: Adults: 300 mg (10 mL) no faster than 5 mL/min Pediatrics: 6 mg/kg (0.2

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Poisoning Pediatrics Seizures Administration 67

Pediatric Education

FEBRUARY 18, 2024

There was no reported respiratory distress or problems handling secretions and no obvious seizure activity. Seizures, cerebrovascular problems and central nervous system tumor swirl in professionals’ heads as they take in the history, physical examination and start to evaluate and manage the problem. How are seizures classified?

Seizures 40

Seizures Pediatrics Psychiatric Radiology 40

Taming the SRU

FEBRUARY 23, 2024

Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs.

Pediatrics 74

Pediatrics Ultrasounds Fractures Wellness 74

PEMBlog

MARCH 27, 2024

My special guest podcaster, Emily Groopman, is an actual Pediatric Geneticist in training and we hope that you will find this episode useful. Pediatr Rev. Pediatrics. Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEM Currents, the Pediatric Emergency Medicine Podcast.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

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. In a metropolitan area, pediatric patients with severe TBI should be transported directly to a pediatric trauma center if available.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

EMDocs

JUNE 9, 2023

If you have restraints in your ambulance, are those restraints appropriately sized for pediatric patients? Because of these factors, the restraint techniques and thresholds to restrain a patient differ from the in-hospital environment. Patients who are in custody or arrested should be accompanied by a law enforcement officer during transport.

EMS 77

EMS Documentation/Coding Pediatrics Psychiatric 77

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