EMDocs

NOVEMBER 6, 2023

Use of 20% intravenous lipid emulsion can be efficacious in the resuscitation of life-threatening local anesthetic toxicity, especially from bupivacaine. Flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias. COR No Benefit, LOE C-EO. COR Harm, LOE B-R. COR 1, LOE C-LD.

Poisoning 103

Poisoning Hyperthermia / Hypothermia Seizures Administration 103

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Airway plan discussed with resuscitation team. They administer two doses of 10 mg midazolam IM.

Seizures 80

Seizures Documentation/Coding EKG/ECG Emergency Department 80

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 84

Seizures Shock Infectious Diseases CPR 84

Taming the SRU

MARCH 30, 2024

Consider ECMO evaluation early for accidental hypothermia arrest Effective rewarming with passive and noninvasive active measures such as Arctic Sun are often effective When a resuscitation warrants deviation for standard ACLS, communicate the reasoning to maintain trust and clarity to help all members of the team actively participate r4 sim and oral (..)

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia Leadership Emergency Department Seizures 94

EMDocs

DECEMBER 6, 2024

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.

Poisoning 85

Poisoning Fluid Resuscitation Seizures Resuscitation 85

EMDocs

AUGUST 17, 2023

Additionally, 80% of patients in the control group required open label NE use indicating that NE was going to be needed in most of these patients regardless of initial resuscitation method. I will continue to reach for pressors early in resuscitation of the septic shock patient. vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, A Randomized Trial.

Sepsis 75

Sepsis Shock Resuscitation Fluid Resuscitation 75

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Benzodiazepines are first-line therapy for seizures. 11) A bolus dose at 1.5

Poisoning 72

Poisoning Seizures Pediatrics EMS 72

Taming the SRU

OCTOBER 5, 2023

Thompson Human factors: how the cognition of individuals or teams intersects with environments in which they work Cognition, biases, intellectual faults, workspace, technology that can work in our favor or work against us Biases: confirmation, availability, anchoring, overconfidence Human errors vs systems errors Triggers for cognitive errors: interruptions (..)

Stroke 90

Stroke EKG/ECG Seizures CPR 90

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. The GCS must be obtained through interaction with the patient (i.e., The GCS must be obtained through interaction with the patient (i.e.,

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Cook County EM Blog

MAY 29, 2023

As resuscitation measures are underway, you obtain collateral from EMS and parents. Signs and symptoms of toxicity include alerted mental status, seizures, CNS depression, apnea, respiratory failure, hypotension, ventricular dysrhythmias, and cardiac arrest. Seizures should be treated with benzodiazepines. 28 June 2019.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

EMDocs

AUGUST 22, 2023

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation.

Emergency Department 76

Emergency Department Blood Transfusions Resuscitation Sepsis 76

Don't Forget the Bubbles

AUGUST 12, 2024

After a traumatic brain injury, all children and young people should have a C-ABCDE rapid assessment for life-threatening injuries (as per ATLS guidelines) focussed on trauma resuscitation and stabilisation, followed by a secondary assessment. Do we need seizure prophylaxis?

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

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.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

The Skeptics' Guide to EM

NOVEMBER 18, 2017

The nurse triages both to beds in the acute/resuscitation area of the department. Will treating with antipyretics prevent a febrile seizure? Antipyretics appear to offer no significant improvement in the recurrence rates of febrile seizures in children. Following the triage sepsis pathway, recently amended to use qSOFA.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

EMDocs

MAY 15, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. 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. times maintenance. Can decrease rate when they are tolerating PO.

Blood Transfusions 87

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 87

Sensible Medicine

JUNE 30, 2023

By the time she died, this management had included intravenous fluids, pain medications, antiemetics, and seizure medications. KS died during the final one when his inpatient team failed to resuscitate him after a cardiac arrest. I managed her evaluation and her care while she remained an outpatient.

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Decreases splinting and improves tidal volumes. Hypervolemia – leads to pulmonary edema: Consider diuresis.

Blood Transfusions 85

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 85

Taming the SRU

JANUARY 12, 2024

Often AE-ILD is idiopathic, but treatable causes must be excluded (PNA, PE, volume overload) Treatment for AE-ILD should include antibiotics for CAP coverage (specifically including azithromycin), steroids, and respiratory support; consider opportunistic infection if immunosuppressed as well as diuresis as needed for euvolemia HFNC should be favored (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

EMDocs

NOVEMBER 1, 2023

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). 4 Fluid resuscitation and vasopressor use as appropriate. upper endoscopy, transesophageal echo, etc.).

Operations 75

Operations Radiology Radiology Fluid Resuscitation 75

EMDocs

JULY 30, 2024

Shortly after this, he began vomiting, and developed a tonic clonic seizure. There was no prodromal illness, recent trauma, polyuria or polydipsia, family history of seizure disorder or diabetes. Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion.

Poisoning 63

Poisoning Seizures Fluid Resuscitation Pediatrics 63

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Emergency Medicine Cases

JULY 31, 2018

In anticipation of EM Cases Episode 113 Diagnosis an Workup of Pulmonary Embolism with Dr. Kerstin DeWit and Dr. Eddy Lang, we have Dr. Peter Reardon telling us his Best Case Ever (Coding in the Scanner) of a young woman who presents with a seizure followed by hemodynamic instability, who codes while in the CT scanner.

Documentation/Coding 52

Documentation/Coding Seizures EMS Resuscitation 52

Mind The Bleep

OCTOBER 17, 2024

Clinically, your enthusiasm for providing maximal quality care needs balanced against rescue practicalities and a hostile environment (very different to your warm, dry resuscitation bay) – the cold makes all veins disappear…and you may be the only clinician responder at the scene. Each year a team usually reports CPR being delivered.

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

ACEP Now

FEBRUARY 11, 2024

Patient C, a 27-year-old female with a history of epilepsy, taking valproate and endorsing adherence, is then brought in by ambulance for a witnessed seizure. This is her first seizure in six years. Management of symptoms is the same for all of these, relying upon fluid resuscitation, antiemetics, and electrolyte repletion.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

Downeast Emergency Medicine

APRIL 26, 2021

We know that if administered too rapidly, it can lead to hypotension and other adverse effects including seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired color vision, and other visual disturbances.[1] Lastly, the use of TXA is not without risk.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Don't Forget the Bubbles

AUGUST 13, 2023

Most febrile seizures are generalized tonic clonic seizures, lasting for a few minutes (less than 10 mins) and are conventionally classified as being simple (70%) and complex (30%). Simple febrile seizures are generalized (i.e. Any febrile seizure lasting for > 30 mins is considered febrile status epilepticus.

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications.

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

Don't Forget the Bubbles

MARCH 18, 2024

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. A similar process can also occur in the CNS (causing seizures ), the liver and the pancreas. 4-year-old Stephanie presents with vomiting, diarrhoea, and lethargy. She appears pale and dehydrated , and her level of alertness fluctuates.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Perhaps diGeorge syndrome with hypocalcemia and seizures? Inborn Errors of Metabolism - there are over 200 inborn errors of metabolism, but only four common metabolic pathways that cause a child to be critically ill. Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines. ACEP/McGraw-Hill, 2013. McGowan et al.

Seizures 40

Seizures Sepsis Pediatrics Shock 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

Dr. Smith's ECG Blog

JANUARY 21, 2023

The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. Seizure activity was witnessed in the ED. EMS reported an initial GCS of 8 with pupils equal and reactive. Is this takotsubo?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

EMDocs

JULY 19, 2023

Further, organic mercury readily crosses the placenta where it acts as a teratogen leading to a wide range of birth defects including developmental delay, blindness, seizures, and limb malformation. 8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated.

Poisoning 74

Poisoning Fluid Resuscitation Administration Seizures 74

Mind The Bleep

SEPTEMBER 12, 2023

Did the baby need resuscitating? Severe jaundice causing kernicterus may also cause central hypotonia and seizures. What were the APGAR signs? If so, were they intubated and admitted to NICU? Were they cooled? Were the cord gases poor?

Sepsis 52

Sepsis Seizures Poisoning Wellness 52

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

EM Ottawa

OCTOBER 5, 2023

Do you remember when every newborn under 30 days with a fever needed an LP/admission/blood cultures? times are a little different but its nuanced. The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician.

Pediatrics 130

Pediatrics Wellness Seizures Resuscitation 130

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

HELLP Syndrome [pdf] Sara Paul MD Intrauterine Fetal Demise [ppt] Irene Hwang, MD Obesity in Pregnancy [pdf] Rafael Garabis, MD Seizures in Pregnancy [ppt] Sherifia Heron , MD Substance Abuse in Pregnancy [ppt] Sophia Y. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Episiotomy [ppt] Alice Teich, MD. Weingart, S.,

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Taming the SRU

APRIL 13, 2023

EtOH, amphetamines, or cocaine) Prescription drugs (i.e. beta blockers decrease ability to dissipate heat through increase CO, diuretics predispose to dehydration, or anticholinergic agents can affect thermoregulation) Clinical Presentation: Temperature elevation, usually 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52