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. The physicians quickly recognized that this was not a seizure and likely cardiac in nature.

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Seizures EKG/ECG Shock EMS 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Definition of status epilepticus:Continuous seizure activity of 5 minutes or greater – OR – Recurrent activity without recovery between intervals. This definition includes clinically apparent seizures as well as those seen only on EEG.) During a seizure, GABA receptors in the neuron’s membrane are internalized and destroyed.

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Pediatrics Seizures Stroke Radiology 40

Dr. Smith's ECG Blog

DECEMBER 26, 2020

Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion. They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. Serial troponins were negative.

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EKG/ECG Stroke Administration Seizures 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.

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Hospitals Hospice Resuscitation COPD 98

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.,

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Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

This was the etiology of seizures. For clarity — I’ve reproduced and have labeled both the initial ECG ( = E CG # 1 ) , as well as the follow-up tracing done 2 days later ( = E CG # 2 ) after correction of the electrolyte disorders ( Figure-1 ). Case outcome The Na was 109. He was treated with hypertonic saline.

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EKG/ECG Seizures Stroke Wellness 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] MI or stroke).

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Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

MARCH 19, 2019

Assuming the heart rate is not too rapid ( this method works less well with heart rates >90-100/minute ) — one may suspect that the QTc will be long if the longest QT interval that you can clearly see on the tracing is more than half the R-R interval. The computer calculated a QTc = 525 ms for the ECG #1.

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EKG/ECG Seizures Stroke Operations 52

Pediatric Education

APRIL 28, 2024

“I’m happy that she is continuing to progress and the physical therapist thinks she will do very well. The pediatrician asked if the parent had any questions about the cerebral palsy diagnosis and the mother said that she had thought she had a problem, but the neonatologist had confirmed it.

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Seizures Pediatrics Dislocations Stroke 40

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.

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Allergic Reactions Seizures Anaphylaxis Leadership 40

Pediatric Education

MARCH 3, 2024

The placenta doesn’t work very well causing problems for mom and baby. The baby doesn’t grow very well so that causes a host of problems including abnormal glucoses. In my experience, small babies don’t feed as well. Eclampsia is a severe complication of pre-eclampsia that has new onset seizures.

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Pediatrics Seizures Wellness Stroke 40

PEMBlog

SEPTEMBER 6, 2023

There is abundant evidence showing that routine lab tests in such patients have a very low yield and are not indicated, in adults as well as in children. Acute onset psychosis is relatively rare.

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 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

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Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 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. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

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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.

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Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

It looks like he has an old anterior lateral MI as well. He had a h/o ischemic cardiomyopathy and right MCA stroke. The patient was awake at this point, lactate was 7 mEq/L and so seizure was suspected as the etiology of the transient loss of consciousness and gaze deviation. I wrote back: "I am looking at his old EKG.

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EKG/ECG Shock Stroke Seizures 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. Don't go looking, if you won't do anything with the test.

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Pediatrics Sepsis Shock Outcomes 52

ACEP Now

APRIL 2, 2024

They are found in large numbers in the mouth, throat, and stomach, as well as throughout the body. 8 Seizures and thunderclap headache from reversible cerebral vasoconstriction syndrome have been reported. These receptors are activated by capsaicinoids, noxious heat (greater than 109.4 to recall the product.

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Burns Poisoning Seizures Stroke 40

Dr. Smith's ECG Blog

MARCH 2, 2019

For example R wave amplitude in lead I is >25mm >22mm in aVL ( whereas 12mm qualifies as LVH ) and well over 25mm in each of leads V3, V4, V5 and V6. QRS amplitude in most leads is either off the page, or overlaps with neighboring leads. may all cause profound QTc prolongation ).

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EKG/ECG Operations Seizures Stroke 52

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. 4 Common symptoms of SAH on presentation include vomiting, neck stiffness, altered mental status or decreased level of consciousness, hemiparesis, and seizure-like activity.

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Seizures Stroke Outcomes EMS 98

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography.

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Emergency Department EKG/ECG Outcomes Seizures 52

The Skeptics' Guide to EM

APRIL 9, 2022

He remained completely awake and alert and otherwise appeared well. Included in this differential is transient epileptic amnesia, transient ischemic attack, stroke, metabolic disorders, psychogenic disorders, and post traumatic amnesia. There was no history of recent trauma, infectious symptoms, or any other illness.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52

EB Medicine

FEBRUARY 1, 2019

Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all.

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Emergency Department Stroke Outcomes Ultrasounds 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

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Stroke Radiology Radiology Emergency Department 105

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

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Sepsis Fractures Documentation/Coding Administration 95

Pediatric EM Morsels

NOVEMBER 15, 2024

Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! We have even talked about using a ketogenic diet to control seizures , and seizure mimics.

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Seizures Stroke Pediatrics Wellness 154

EMDocs

NOVEMBER 4, 2024

Headache red-flag characteristics include neurological symptoms, thunderclap nature, syncope, trauma, immunocompromised, coagulopathy, fever, rash, seizure, nuchal rigidity, altered mental status, pregnancy, temporal tenderness, jaw claudication, and cancer history. This post focuses on pain management for benign headaches.

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Emergency Department Fractures Burns EMS 105

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

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Seizures Fractures EKG/ECG Resuscitation 75

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. Do not use pethidine since it can cause seizures and CNS hyperexcitability. What is the role of transcranial dopplers in primary prevention of strokes?

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Blood Transfusions Stroke Dehydration Sepsis 126

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,

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Documentation/Coding Seizures Psychiatric Wellness 64

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Moreover, it does not follow a coronary distribution very well. The QTc looks prolonged ( well over half the R-R interval ) although accurate QTc assessment becomes challenging at this rapid a rate. By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL.

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EKG/ECG Resuscitation EMS Seizures 89

PEMBlog

MAY 9, 2024

Febrile Seizures are among the most common neurological problema in young children, occurring in 1 out of 50 children between the ages of 6 months and 5 years of age. Febrile Seizure. Common variants associated with general and MMR vaccine-related febrile seizures. Updated 2024 Jan 19]. In: StatPearls [Internet]. Ann Emerg Med.

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Seizures Pediatrics Wellness Emergency Department 59

EMDocs

FEBRUARY 3, 2025

These complications affect both the central and peripheral nervous systems and encompass a wide range of conditions, including transient ischemic attacks (TIA), stroke, headaches, mood disorders, seizures, psychosis, neuropathy, and cognitive dysfunction (1,6,7).

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Stroke EMS Seizures Outcomes 71

EMDocs

NOVEMBER 2, 2024

The CSF studies return positive for CSF VDRL as well as for CSFfluorescent treponemal antibody-absorption test (FTA-ABS), with 75 WBCs/microL and a CSF protein of 60 mg/dL and elevated opening pressures. cognitive and behavioral impairment) – 33% Ataxia – 28% Stroke – 23% Ophthalmic symptoms (e.g., Symptoms: Personality change (i.e.,

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EMS Infectious Diseases CDC Research 115

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.

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Infectious Diseases CDC PPE Rapid Diagnostic Testing 75