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Choosing Wisely – Investigations for seizures that have returned to baseline

Don't Forget the Bubbles

Do not order laboratory testing or a CT scan of the head for a patient with an unprovoked, generalized seizure or a simple febrile seizure who has returned to baseline mental status. The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. Investigators found that 99.3%

Seizures 131
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ToxCard: Iron

EMDocs

Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. Consider intubation for patients with airway compromise, respiratory failure, altered mental status, or seizure. 5 Seizure: IV benzodiazepine first line, barbiturates as second line.

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You don’t need labs or CT scans in children who have recovered after a simple febrile or first time seizure

PEMBlog

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.

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TXA in head injuries

Don't Forget the Bubbles

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. She’s wheeled to radiology. But that’s not where it ends.

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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

E.g. burns, neurosurgery, interventional radiology. 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. Clinical Radiology: Major paediatric trauma radiology guidance.

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What Are the Classifications of Perinatal Stroke?

Pediatric Education

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

Stroke 52
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emDOCs Revamp: Esophageal Perforation

EMDocs

1 , 2 The most common non-iatrogenic cause is spontaneously due to increased intraesophageal pressure, Boerhaave syndrome, from forceful retching, coughing, straining, seizures, or even childbirth (15% of cases). upper endoscopy, transesophageal echo, etc.). Discuss with GI/surgeons prior to placement.