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.

Seizures 122

Seizures Pediatrics Research Wellness 122

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 Administration 52

PEMBlog

SEPTEMBER 13, 2023

Team members and families eagerly await your intervention to halt the seizure and understand its underlying cause. This harm can manifest through the discomfort of blood draws and urine catheterizations, as well as the radiation exposure involved in head CT scans. This includes scarring abnormalities, bleeds, and tumors.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

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 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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

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

NOVEMBER 6, 2023

Because venoarterial extracorporeal membrane oxygenation implementation takes time, the process should be started early in patients who are not responding well to other therapies. Flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias. COR No Benefit, LOE C-EO.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

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.

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

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

RebelEM

JULY 10, 2024

Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Red flags in patients with headaches that may suggest a brain tumor include signs of increased intracranial pressure, focal neurological signs, seizures or ataxia. Red flags in patients with. Read more

Seizures 58

Seizures Administration EMS Wellness 58

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. This is an SGEM Xtra and it was inspired by the recent publication in Pediatrics on BRUEs. […] The post SGEM Xtra: Strange BRUE first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Seizures CPR Hospitals 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

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. JAMA Pediatr.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

PEMBlog

SEPTEMBER 6, 2023

However, the vast majority of pediatric patients with psychiatric complaints do not present with undifferentiated acute psychosis; rather, they are seen for behavioral concerns or suicidal ideation. Decades ago, psychiatric complaints in the pediatric ED were infrequent. Acute onset psychosis is relatively rare.

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52

Pediatric Emergency Playbook

APRIL 1, 2016

Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids? This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care. The punchline is, use a pediatric reference.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

MAY 1, 2017

Pediatrics. Pediatrics. Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. This will tell you: home or admission. Use the Bilitool or Bhutani Nomogram (below).

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric Education

APRIL 28, 2024

“I’m happy that she is continuing to progress and the physical therapist thinks she will do very well. JAMA Pediatr. Adv Pediatr. Adv Pediatr. D’Alessandro, MD Professor of Pediatrics, University of Iowa We’ll just have to see with time. 2017;171(9):897-907. doi:10.1001/jamapediatrics.2017.1689

Seizures 40

Seizures Pediatrics Dislocations Stroke 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make determinations on three key domains: appearance, work of breathing, and circulation to the skin. Pediatr Clin N Am. You have all of the skills you need to care for an acutely ill infant. 2006; 53:69-84.

Seizures 40

Seizures Sepsis Pediatrics Shock 40

PEMBlog

OCTOBER 2, 2024

In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast , I explore the complexities of gastroesophageal reflux (GER) and gastritis in children and adolescents. Topics covered include: The pathophysiology of GER and GERD in the pediatric population. J Pediatr Gastroenterol Nutr. J Pediatr Gastroenterol Nutr.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Advanced Emergency Nursing from AENJ

NOVEMBER 7, 2015

Even as a Paramedic, in the early days, there was no analgesia, sedative (except for seizures), or anesthetic, to provide. " Well, then, what to do? Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC pediatrics, 2(1), 11. [ We had only first aid, oxygen, and CPR to offer.

Emergency Department 40

Emergency Department Pediatrics Emergency Nursing Seizures 40

Pediatric Education

AUGUST 11, 2024

He is described as being a quieter child but is well-liked at school and has friends at home and school that he plays with. There was no history of seizures, abnormal staring spells, abnormal or erratic behavior, unusual or neurological infections and no specific travel history. 2018;57(5):308-312. doi:10.1016/j.jaac.2018.01.021

Psychiatric 40

Psychiatric Infectious Diseases Pediatrics Seizures 40

Taming the SRU

APRIL 13, 2023

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. EtOH, amphetamines, or cocaine) Prescription drugs (i.e. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

If doing what was called "the one-man-band resurrection shuffle" [single person CPR in the back of a moving ambulance], this worked very well, as the bag would stay hanging there on the patient's face. How useful these would have been to let us know how well the patient was oxygenating and ventilating!

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Pediatric Education

MAY 7, 2023

The fever was responsive to antipyretics, and he was taking some dextromethorphan as well. Pediatr Neurol. D’Alessandro, MD Professor of Pediatrics, University of Iowa Maximum temperature was 102.4F 5 days ago. The last recorded temperature was the evening before at 100.1F. J Am Acad Child Adolesc Psychiatry.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Infectious Diseases Pediatrics Poisoning 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. In contrast, Kochanek reviewed each meta-analysis, as well as the RCT and secondary analyses, separately to assess overall results and potential moderators of effect. Doi:10.4266/acc.2022.01291

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

Pediatric EM Morsels

NOVEMBER 3, 2023

ovale to cover the hypnozoite that can stay dormant in the liver and cause a secondary infection in the future Severe Malaria IV artesunate is currently the accepted first line treatment Previously IV quinine was first line, however it was associated with higher incidence of hypoglycemia, cardiac dysrhythmias, seizures, and comas.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

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 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

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

Don't Forget the Bubbles

APRIL 7, 2025

It can present with jitteriness, poor feeding, prolonged jaundice, seizures, bluish skin discolouration (cyanosis), lethargy, or even acute collapse. Depending on the size and location, children may develop neurological symptoms, such as seizures, developmental delays, or visual disturbances due to compression of the optic pathways.

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

Don't Forget the Bubbles

JUNE 30, 2023

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. But the evidence is a bit contrary – the systematic review and meta-analysis found no increased risk of seizures in the 14 included studies.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 In one study, almost all patients who went on to develop seizures had tachycardia prior to the seizure.

Seizures 91

Seizures EKG/ECG Poisoning Shock 91

Downeast Emergency Medicine

MARCH 24, 2021

OVERVIEW Diarrhea is a common complaint for our pediatric patients in the emergency department. Most pediatric diarrhea is not life threatening, and usually is treated with supportive care. However, there are important red flags to consider when assessing a pediatric patient with diarrhea. Pediatr Emerg Care 1997, 13(3):179-182.

Pediatrics 52

Pediatrics Dehydration Emergency Department Wellness 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2016

in Pediatrics reported on children with headache suspected of having a brain tumor. in Pediatrics did a systematic review of Clinical Features Suggestive of Meningitis in Children. Headache plus… a new seizure. Pediatrics. Medina et al. Go after the diagnosis when it meets your threshold for testing. Dr Curtis et al.

Pediatrics 52

Pediatrics Seizures Emergency Department 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. 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 Pediatrics 98

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Taming the SRU

FEBRUARY 23, 2024

Total RBC count (<500 RBCs in last tube), as well as clearance by the last tube (decrease in RBC count by at least 70% by the last tube), can be used to differentiate between traumatic taps and a SAH. If assessing for SAH, xanthochromia may not appear until 12 hours after onset, though may appear after 2-4 hours.

Pediatrics 75

Pediatrics Ultrasounds Fractures Wellness 75

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