The Skeptics' Guide to EM

DECEMBER 15, 2018

Acetaminophen and febrile seizure recurrences during the same fever episode. He specialises in Paediatric Emergency Medicine and is a passionate […] The post SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen? Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics.

Seizures 52

Seizures Pediatrics Emergency Department Outcomes 52

PEMBlog

SEPTEMBER 13, 2023

Team members and families eagerly await your intervention to halt the seizure and understand its underlying cause. This harm can manifest through the discomfort of blood draws and urine catheterizations, as well as the radiation exposure involved in head CT scans. This includes scarring abnormalities, bleeds, and tumors.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

Pediatric EM Morsels

DECEMBER 20, 2024

Keep in mind, there can be extrapulmonary manifestations as well! Joint pain Hemolytic anemia due to the presence of IgM antibodies on RBCs causing autoimmune hemolysis Rarely neurological complications such as meningoencephalitis, seizures , transverse myelitis , GBS , and cerebellar ataxia.

CDC 130

CDC Seizures Pediatrics EMS 130

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 115

EKG/ECG Seizures Wellness EMS 115

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

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 Administration Poisoning 114

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 75

Seizures Shock Infectious Diseases CPR 75

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 64

Seizures Administration Anaphylaxis Outcomes 64

Don't Forget the Bubbles

JUNE 30, 2023

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. But the evidence is a bit contrary – the systematic review and meta-analysis found no increased risk of seizures in the 14 included studies.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

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

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 61

Seizures Emergency Department Hyperthermia / Hypothermia EMS 61

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

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 96

EMS Resuscitation Blood Transfusions Seizures 96

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.

Seizures 40

Seizures EKG/ECG Shock EMS 40

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

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 94

Poisoning Hyperthermia / Hypothermia Seizures Administration 94

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 90

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 90

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 120

EKG/ECG Seizures Hospitals Stroke 120

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 127

Pediatrics Wellness Seizures Resuscitation 127

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

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

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

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 76

Poisoning Fluid Resuscitation Seizures Resuscitation 76

Pediatric EM Morsels

AUGUST 18, 2023

Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. So, in the right clinical situtation, the benefits of the fluoroquinolone use in children may outweigh the risk.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

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

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Acute hepatitis Disulfiram-like reaction with ethanol consumption Pneumonitis from inhalation of spores Seizures from glutamate agonist activity [Image from Canstockphoto] Reveal the Answer 2.

Seizures 67

Seizures Academics Wellness 67

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 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 101

Pediatrics EMS Wellness Seizures 101

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

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