Don't Forget the Bubbles

JANUARY 24, 2024

Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management. What causes Super Refractory Status Epilepticus?

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

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.

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Seizures Emergency Department Wellness 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.

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Seizures Pediatrics CDC Infectious Diseases 278

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. of the risk of pneumonia by not intubating patients (NNT = 13) Additionally there was an absolute reduction of 12.2%

Poisoning 141

Poisoning Airway Management Seizures Shock 141

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

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Seizures Administration EMS Wellness 59

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

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

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.

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Seizures Sepsis Stroke Administration 75

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 74

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 74

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 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 52

Seizures EKG/ECG Shock EMS 52

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

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

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.

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EKG/ECG Seizures Wellness EMS 107

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

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.

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EMS Resuscitation Blood Transfusions Seizures 96

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

JUNE 26, 2023

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

Seizures 52

Seizures Best Practices Wellness Outcomes 52

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

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.

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Poisoning Hyperthermia / Hypothermia Seizures Administration 94

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.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

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

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

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

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 Best Practices Burns Academics 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.

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Seizures Wellness Hospitals 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.

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Seizures Academics Wellness 67

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

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

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 112

EKG/ECG Seizures Hospitals Stroke 112

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

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.”

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Seizures Emergency Department Pediatrics Critical Access 52

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

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.

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Pediatrics Wellness Seizures Resuscitation 124

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.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Pediatric EM Morsels

APRIL 7, 2023

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

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Stroke Pediatrics Seizures Sepsis 130

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.

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Pediatrics Ultrasounds Fractures Wellness 74