Northwestern EM Blog

FEBRUARY 4, 2025

Written by: Dean Hayes (NUEM 27) Edited by: Andrew Long (NUEM 25 ) Expert Commentary by: Rafael Lima, MD A mid 20s male presents to the ED after seizure-like activity. Per the patient's partner at bedside, he had a 2-3 minute convulsive episode and the description is consistent with a likely seizure. and Can Kratom cause seizures?

Seizures 72

Seizures Poisoning Forensics Emergency Department 72

EMDocs

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 97

Seizures Hyperthermia / Hypothermia Emergency Department EMS 97

EMDocs

MAY 25, 2023

Design: Multi-centered, double-blinded, randomized trial PICO: Population: Inclusion Criteria: Age 2 years and older Must have been treated with a specified minimum dose of certain benzodiazepines for generalized convulsive seizures: Intravenous or rectal diazepam 0.3 Study included children, as well as adults.

Seizures 70

Seizures Administration Anaphylaxis Outcomes 70

Dr. Smith's ECG Blog

DECEMBER 9, 2023

Inferior Aneurysm morphology is incredibly hard to differentiate from Acute OMI, but you should suspect it whenever there are well-formed inferior Q-waves. No chest pain, no shortness of breath, no back pain, no numbness, weakness, tingling, no seizures or history of seizures, First ED ECG This still shows apparent inferior OMI.

EKG/ECG 118

EKG/ECG Seizures Wellness EMS 118

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

ALiEM

MARCH 5, 2024

Cases of toxicity have been reported following ingestion of supplements as well as ingestion of willow bark tea [4,5]. With severe toxicity, patients can have altered mental status, seizures, hyperthermia, and pulmonary edema. Willow tree bark supplements are available as tablets, tinctures, powders, or tea.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here.

EMS 105

EMS Resuscitation Blood Transfusions Seizures 105

Emergency Medicine Ireland

APRIL 29, 2024

They have a seizure on arrival and a Na comes back at 105. In this scenario they are seizing because of the low Na and rapid increase of the Na is needed to stop the seizure. The sodium rises, the patient stops seizing everyone relaxes but then the Na continues to rise, well above the 5mmol we wanted and a panic ensues.

Seizures 75

Seizures Sepsis Stroke Administration 75

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

EMDocs

NOVEMBER 6, 2023

Because venoarterial extracorporeal membrane oxygenation implementation takes time, the process should be started early in patients who are not responding well to other therapies. Flumazenil administration is associated with harm in patients who are at increased risk for seizures or dysrhythmias. COR No Benefit, LOE C-EO.

Poisoning 103

Poisoning Hyperthermia / Hypothermia Seizures Administration 103

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

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest.

EKG/ECG 127

EKG/ECG Seizures Hospitals Stroke 127

RebelEM

JULY 10, 2024

Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Red flags in patients with headaches that may suggest a brain tumor include signs of increased intracranial pressure, focal neurological signs, seizures or ataxia. Red flags in patients with. Read more

Seizures 58

Seizures Administration EMS Wellness 58

Don't Forget the Bubbles

OCTOBER 23, 2023

It is well worth looking at videos of spasms to familiarise yourself with the potential presentation – look at the awareness video at the end of this blog. They may also already have other seizure types and be under paediatric services. Maintenance therapy is sometimes required in patients with higher seizure risks.

Seizures 75

Seizures Outcomes Wellness 75

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

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

PHEM Cast

MARCH 31, 2019

Her excellent books “It’s all in your head” and “Brainstorm” are well worth a read. Non-epileptic seizures = dissociative seizures. [link] Many thanks to Suzanne O’Sullivan for her time in putting this podcast together. It is certainly one of the PHEMcast recordings which is going to change my own practice the most.

Seizures 52

Seizures Wellness 52

JournalFeed

OCTOBER 12, 2024

Tuesday Spoon Feed : ACEP released a clinical policy that addresses the choice of a second-line agent for adults with refractory seizures after adequate dosing of benzodiazepines. This article provides an overview of CST as well as some pearls for clinching this diagnosis for emergency medicine physicians.

Seizures 52

Seizures Emergency Department Wellness 52

Taming the SRU

JUNE 26, 2023

While these programs differ, many have shown improvement in perceived wellness among residents.

Seizures 52

Seizures Best Practices Wellness Outcomes 52

Taming the SRU

DECEMBER 17, 2024

Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Hospitals can purchase ORT packets for use in EDs as well as giving patients the formula to make their own at home. AtherlyJohn et al. A systematic review by Freedman et al. IV fluid administration was more associated with phlebitis.

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

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 85

Poisoning Fluid Resuscitation Seizures Resuscitation 85

Emergency Medicine Cases

JULY 8, 2024

How do the Canadian and American guidelines on work up of well-appearing febrile infants compare when to it comes to indications for lumbar puncture? We answer such questions as: what are the test characteristics of the various clinical features of meningitis across various ages?

Pediatrics 109

Pediatrics EMS Wellness Seizures 109

Medagadget

MAY 23, 2023

The technology could prove very useful for brain surgeons who wish to map regions of the brain that may be triggering epileptic seizures and then target these lesions surgically. Reducing the area of the skull that is removed during surgery helps to speed patient recovery and reduce the trauma associated with such procedures.

Research 71

Research Seizures Wellness 71

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.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Mind The Bleep

MAY 16, 2023

It also requires exclusion; even though the child in front of you appears well they still need a thorough history and examination to make sure there isn’t something more concerning going on. Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 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

Emergency Medicine Ireland

MARCH 22, 2021

Unfortunately its rarity does not get us out of having to know it very well as it is an exam favourite. To have eclampsia you simply need to have seizures in addition to the above. The priorities here will be * seizure prevention and treatment. * Any further seizures can be treated with another 2g of magnesium.

Seizures 40

Seizures Wellness Hospitals 40

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 74

Pediatrics Ultrasounds Fractures Wellness 74

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

The Skeptics' Guide to EM

NOVEMBER 18, 2017

In contrast, fever may actually be of benefit; thus, the real goal of antipyretic therapy is not simply to normalize body temperature but to improve the overall comfort and well-being of the child.” Will treating with antipyretics prevent a febrile seizure? Antipyretics should be used to improve comfort during an illness.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 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. This patient had her first seizure in years despite adherence to her valproate for management of her epilepsy.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

EMDocs

AUGUST 22, 2023

In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause.

Emergency Department 76

Emergency Department Blood Transfusions Resuscitation Sepsis 76

ALiEM

JUNE 1, 2023

Well not exactly. NMDA Receptors: Role in Ethanol Withdrawal Seizures. Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? 2011;29(4):382-385. 2009.10.010.

Administration 98

Administration Emergency Department Seizures Hospitals 98

Mind The Bleep

DECEMBER 10, 2023

Some individuals may require further medical investigations to exclude co-morbidities, for example an EEG to look into seizure disorders, or genetic testing to look for chromosomal and genetic anomalies. Hearing and vision assessments should also be carried out in order to address any sensory difficulties.

Seizures 52

Seizures Burns Best Practices Academics 52

Mind The Bleep

OCTOBER 17, 2024

Seizures, chest pain, intoxication, and deliberate self-harm were also reported. Other treatments are available for nausea, respiratory depression, cardiac pain, seizures, hypoglycaemia, and asthma. Medics have much to offer teams in various aspects of the above, but the ability to help with the day-to-day tasks is important.

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. The seizure abated with rectal diazepam given by the squad. You notice a med-alert bracelet with the patient’s name and the word “SEIZURES.”

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52