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

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

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. These targets can be achieved by using short-acting, titratable intravenous medications such as beta-blockers or nicardipine [1].

Stroke 101

Stroke Outcomes EMS Seizures 101

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

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

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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Mind The Bleep

DECEMBER 31, 2023

Damaged kidneys don’t handle drugs well Or fluids! Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. If the patient is an outpatient, they should be called to check they are well. Be gentle with both.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. 2013; 29:715-719.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

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.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

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 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1, RR 28, SpO2 89% on 6L NC.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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 93

Seizures EKG/ECG Poisoning Shock 93

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 Pediatrics 98

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 95

Emergency Department Blood Transfusions Resuscitation Sepsis 95

EMDocs

OCTOBER 5, 2024

ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. IV fluid resuscitation as needed.

EMS 98

EMS Infectious Diseases Sepsis Hospitals 98

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

Sensible Medicine

JUNE 30, 2023

On the other hand, KW was a middle-aged American man with chest pain and significant risk factors for coronary artery disease – hypertension and diabetes – neither of which had ever been terribly well-controlled. She was well hydrated and her vital signs were normal. PH is a woman I have written about in the past.

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

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

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

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Contraindicated seizures or porphyria. Resuscitation 2013; 84(11): 1500 – 4. Minimal histamine release.

Emergency Department 93

Emergency Department Soft Tissue Injuries Operations Airway Management 93

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

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

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. 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.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Taming the SRU

FEBRUARY 22, 2023

STEP-UP Self Physical and Psycological IM-SAFE Illness Medications Stress Alcohol Fatigue Eating Psychological Cognitive Threat/Challenge appraisal: PERCEIVED demands vs. resources Threat appraisal - stress levels excessive, performance impaired – vapor lock (autonomic arousal, tunnel vision, auditory exclusion, loss of time awareness, impaired memory (..)

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

Taming the SRU

MAY 30, 2023

Legal implications vary from country to country. mg/mL) single-dose 2*-mL ampule or equivalent, 2 Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2 Nitroglycerin, 0.4-mg

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Critical Care Now

JUNE 21, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. His coach and fellow players witnessed a seizure-like activity immediately after collapsing. Other beta-blockers can be used here as well. -It Polymorphic VT induced by physical or emotional stress.

Seizures 52

Seizures EKG/ECG CPR Shock 52

Pediatric Education

NOVEMBER 10, 2024

Per the parents through an interpreter the baby was doing well. Note that some people will add clinically important bacterial infections such as Group B Streptococcus , Escherichia coli , and Listeria to this list as well. What are the basic first steps for newborn resuscitation?

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Resuscitation 40

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. Resuscitation was begun with chest compressions, etc., Moreover, when someone has immediate resuscitation of an arrest witnessed by paramedics, they rarely have a GCS of 3 (deep coma). Moreover, it does not follow a coronary distribution very well. Not a shockable rhythm.

EKG/ECG 88

EKG/ECG Resuscitation EMS Seizures 88

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

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? El-Baba, Dell and McLaren.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Taming the SRU

AUGUST 25, 2023

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 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

MARCH 11, 2024

Rehydration therapy for patients with cholera should include volume resuscitation and electrolyte repletion. Patients who cannot tolerate oral intake of fluids should receive intravenous (IV) fluid resuscitation but are encouraged to start drinking ORS as soon as they are able.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111

EMDocs

JANUARY 6, 2025

She presents with a seven-day history of fever, fatigue, and myalgias associated with decreased oral intake and an episode of seizure-like activity three hours prior to arrival. Additionally, there is no family history of seizure disorders. A review of systems is notable for nausea and vomiting but no diarrhea.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75