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

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

SEPTEMBER 1, 2023

Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Dr. Smith's ECG Blog

MARCH 30, 2014

Case A female in her 60s presented with 3 days of nausea, vomiting, and diarrhea, and not feeling well. 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. Previous ECG. Was there pulmonary edema?

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

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). Caution with use of NIPPV – positive pressure can worsen injury as well as increase subcutaneous emphysema.

Operations 75

Operations Radiology Radiology Fluid Resuscitation 75

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. We now have a patient who is in sustained SVT but with no features of shock.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus. There are also diagonal branches which are not well visualized.

EKG/ECG 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Mind The Bleep

DECEMBER 16, 2023

However, patients do not always notice mosquito bites.

Rapid Diagnostic Testing 52

Rapid Diagnostic Testing Infectious Diseases Best Practices 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

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

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 Seizures Emergency Department 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! Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

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

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. It looks like he has an old anterior lateral MI as well. Still Irregular Blood pressure during these rhythms was adequate; there was no shock. It does not show RBBB but does show Left anterior fascicular block.

EKG/ECG 52

EKG/ECG Shock Stroke 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. Journal of Emergencies, Trauma and Shock, 3(1), 39. Not in the textbook, but it worked.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

PEMBlog

OCTOBER 2, 2024

Children with respiratory conditions and chronic lung disease like asthma are more prone to GERD as well. This is sometimes misidentified as seizures. So, the parents may say, well, he Doesn’t ever seem full. Well, baby doesn’t know how to be full. So celiac disease can cause dyspepsia symptoms as well.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. 6 Seizures have been observed and are dose-dependent.

Poisoning 99

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 99

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 74

Seizures EKG/ECG Poisoning Shock 74

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., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

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

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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. Learning Points : 1.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Pediatric Emergency Playbook

MAY 1, 2017

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. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Critical Care Now

JUNE 21, 2022

His coach and fellow players witnessed a seizure-like activity immediately after collapsing. Paramedics continued chest compressions, gave epinephrine via an intraosseous route, and delivered one shock. Other beta-blockers can be used here as well. -It After that a return of spontaneous circulation (ROSC) occurred.

Seizures 52

Seizures EKG/ECG CPR Shock 52

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 83

EMS Infectious Diseases Sepsis Hospitals 83

Dr. Smith's ECG Blog

DECEMBER 5, 2019

How well does the computer interpretation perform? -- in this case, the computer diagnosed STEMI but the patient had Fever with Brugada _ _ Fever and Brugada-- Important articles The literature below shows that fever-induced Brugada is indeed a high risk for an arrhythmic event. Syncope and ST Segment Elevation. And another finding.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 The rhabdo is believed to be due, in part, to associated seizures, muscle tremors, and agitation. Jeff: And the etiology of CHS is not well understood. million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. 18 Patients with signs and symptoms of severe dehydration or shock, including stupor, coma, uncontrollable vomiting, extreme fatigue that prevents drinking, and unstable vital signs should receive IV fluid resuscitation.

Dehydration 99

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 99

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. However, IgE-mediated or not, anaphylactic shock is possible in either case. 8 The data in Mayer et al.

Stroke 96

Stroke Radiology Radiology Emergency Department 96

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 65

Infectious Diseases CDC PPE Rapid Diagnostic Testing 65