EMDocs

JANUARY 8, 2024

Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia (Level 3: no benefit). o C recommended (Level 1: strong). COR 2a, LOE B-NR.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

Dr. Smith's ECG Blog

MARCH 11, 2012

A young man presented after a prolonged seizure. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Approach to Wide Complex Tachycardia Unstable – Shock it 12-lead if at all possible --Unstable defined by : Chest Pain Shock Hypotension Very dyspneic Pulmonary Edema Stable Get a 12-lead ECG Sinus?

Seizures 52

Seizures Shock EKG/ECG Outcomes 52

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 97

Seizures Shock Infectious Diseases CPR 97

RebelEM

SEPTEMBER 27, 2023

If QRS >100 msec = 33% chance of seizures If QRS >160 msec = 50% of ventricular dysrhythmias Often extrapolated to other sodium channel blocking agents: diphenhydramine, loperamide, cocaine, lamotrigine, Type 1A/1C Anti-Dysrhythmics. As a result, it is essential to replete potassium simultaneously. N Engl J Med. PMID: 4022081.

Poisoning 105

Poisoning Seizures Administration EKG/ECG 105

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% I will continue to reach for pressors early in resuscitation of the septic shock patient.

Sepsis 93

Sepsis Shock Resuscitation Fluid Resuscitation 93

Taming the SRU

JUNE 3, 2024

Get a blood gas when possible to help guide your ventilation. glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Will treating with antipyretics prevent a febrile seizure? Critical Care Medicine 2017.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Dr. Smith's ECG Blog

JULY 14, 2010

Before EMS arrived, she had "seizure activity" and became unresponsive. She arrived comatose and in cardiogenic shock and the following ECG was recorded. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She was intubated.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 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.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Dr. Smith's ECG Blog

MARCH 30, 2014

They were worried that the syncope was seizure and that she had brain mets. Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Cardiologist note says: "Elevated troponin explained by type II MI due to her shock." Previous ECG. The lactate was elevated and pH low.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

Dr. Smith's ECG Blog

JUNE 26, 2023

Most occurrences are associated with events such as sepsis, shock, recent infarction, post-operative state, electrolyte disturbance — or "sick patient". Seizure activity was witnessed at the scene — and head CT scan showed a small bleed. PEARL # 5: Accelerated junctional rhythms are not common in adults.

EKG/ECG 97

EKG/ECG Seizures Sepsis Operations 97

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

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. Still Irregular Blood pressure during these rhythms was adequate; there was no shock. Alternatively , it is someone who has an old myocardial infarction and is now very sick with something else.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

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

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

Meanwhile, the patient has just returned from a scan and had a seizure in front of you because his brain is speckled with contrast; post-ictus, he's apneic despite airway measures, and now one must give mouth-to-mouth because there's no bag at the bedside … see what I mean? Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

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

PEMBlog

OCTOBER 2, 2024

This is sometimes misidentified as seizures. or somebody who appears pale, dehydrated, in severe pain, or worse, even in shock. And they can have Sandefur syndrome, which is the arching of the back and dystonic posturing that occurs during or after feeds as a response to discomfort from acid reflux.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. Characterized by hypovolemia, vasodilation, reduced cardiac output, hyperventilation, elevated temperature, seizure, coma, and cardiovascular collapse. 1 Obtain a single view abdominal x-ray.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. He reports no personal or familial history of seizures. When the physicians approached him, he was ashen, diaphoretic, and appeared in shock.

Seizures 40

Seizures EKG/ECG Shock EMS 40

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

PulmCCM

JANUARY 29, 2024

three shocks with 2 minutes CPR in between) have been performed. EEG Advised, to Rule Out Nonconvulsive Seizures Nonconvulsive seizures are occasionally present in comatose patients after cardiac arrest, undetectable without testing. Seizure prophylaxis was advised against, as there is no evidence for its efficacy.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

Don't Forget the Bubbles

FEBRUARY 5, 2025

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. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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

Taming the SRU

SEPTEMBER 24, 2023

Patients with a history of seizures, supratentorial structural brain pathologies, post-arrest, or unexplained altered mental status should prompt suspicion for NCSE. However, Ceribell is a useful technology to help detect seizure activity and affect disposition. Two main theories behind the development of PRES. (1)

Seizures 52

Seizures EKG/ECG Emergency Department Shock 52

EMDocs

DECEMBER 16, 2023

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. Clinical decision making in seizures and status epilepticus. Updated 2022 Oct 24].

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

Ziqitza HealthCare Ltd

JUNE 13, 2024

However, if severe instances are not addressed, they can lead to shock or kidney failure. Severe or persistent vomiting or diarrhea Prolonged episodes of severe vomiting or diarrhea can cause electrolyte imbalances and dehydration. Common reasons include infections, gastrointestinal issues, and food poisoning.

Burns 52

Burns Stroke Ambulance Services Seizures 52

EMDocs

OCTOBER 5, 2024

Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 Imipenem confers highest risk of seizures ESBL-E are often hospital acquired infections and can prolong hospital stay or lead to worse outcomes. IV fluid resuscitation as needed. mcg/kg/min and titrated to MAP >65).

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Taming the SRU

JANUARY 26, 2024

Yates Case 1: Stroke and Stroke Mimics Early diagnosis of stroke improves stroke outcomes, where misdiagnosis is associated with an upwards of 4-time higher likelihood of mortality Missed strokes most often occur with atypical symptoms, in younger aged patients, those with posterior strokes, and those with lower NIH scores It can be difficult to discern (..)

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). Jenkins and Frick — or additional procedures may be ordered and/or patients shocked for artifact simulating VT/VFib ). The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64

Don't Forget the Bubbles

JULY 26, 2023

Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98