EMDocs

JANUARY 8, 2024

Avoid routine seizure prophylaxis in adult survivors of cardiac arrest (Level 3: no benefit), but treat seizures if they occur (Level 1: strong). Routine administration of calcium for treatment of cardiac arrest is not recommended. Seizure prophylaxis in adult survivors of cardiac arrest is not recommended.

Seizures 80

Seizures Shock CPR Hyperthermia / Hypothermia 80

EMDocs

APRIL 10, 2024

She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration.

Advances Cardiac Life Support (ACLS) 91

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 91

EMDocs

MARCH 2, 2024

A) Administration of mannitol B) Admission for observation C) Discharge home D) Discharge home with oral steroids Answer: B The patient has a skull fracture with an overlying laceration. Administration of mannitol (A) is indicated for patients with elevated intracranial pressure.  2022 Mar;18(2):253-255.  J Int Adv Otol. 2020

EMS 112

EMS Fractures Seizures Head Injuries 112

Cook County EM Blog

MAY 29, 2023

Signs and symptoms of toxicity include alerted mental status, seizures, CNS depression, apnea, respiratory failure, hypotension, ventricular dysrhythmias, and cardiac arrest. If a therapeutic dose is chewed, it can lead to bronchospasm, laryngospasm, seizures, and cardiovascular collapse which further reinforces the danger to children.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66

EMDocs

JANUARY 17, 2024

The US Food and Drug Administration (FDA) approved benzonatate in 1958 for cough relief in patients ≥ 10 years. Benzodiazepines are first-line therapy for seizures. Analysis of benzonatate overdoses among adults and children from 1969-2010 by the United States Food and Drug Administration. 11) A bolus dose at 1.5

Poisoning 66

Poisoning Seizures Pediatrics Administration 66

RebelEM

NOVEMBER 16, 2022

benzocaine) Consider the diagnosis in any patient with cyanosis and hypoxia that doesn’t respond to oxygen administration Administer methylene blue to any patient with abnormal vital signs, metabolic acidosis, end organ dysfunction or, a serum level > 25% References: Price DP. Chapter 127. Read more

Seizures 52

Seizures Administration Airway Management COPD 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

ACEP Now

APRIL 2, 2024

1 In severe cases altered mental status, seizures, coma, or even death have been observed. Due to concerns regarding THS, the import of ackee fruit was outlawed in 1972, but since 2000 canned exports have been allowed by certain “green listed” manufacturers by the Federal Drug Administration. Food and Drug Administration website.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40

PulmCCM

DECEMBER 10, 2023

Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin.

Seizures 52

Seizures Sepsis Academics Administration 52

ALiEM

JUNE 1, 2023

Administration of benzodiazepines or barbiturates to these patients risk inducing a prolonged comatose state. The concern with concurrent phenobarbital and benzodiazepine administration is oversedation. There is a dearth of evidence about which patients require medical admission in the setting of phenobarbital administration.

Administration 98

Administration Emergency Department Seizures Hospitals 98

EMDocs

FEBRUARY 15, 2024

Physostigmine does not reverse seizures or dysrhythmias. 7 Administer this antidote slowly via intravenous route over several minutes (5-10 minutes), as rapid administration is associated with seizures and bradycardia. Physostigmine does not reverse seizures or dysrhythmias. 9 Physostigmine dosing: 0.5-2

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Poisoning Seizures COPD 88

Don't Forget the Bubbles

JUNE 30, 2023

As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. There was a small increased risk of seizures in the TXA group – 0.3% (7 children) of the 1900 children in the TXA group vs none of the 1900 children in the non-TXA group. But that’s not where it ends. The evidence is a mixed bag.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

EMDocs

JUNE 7, 2023

Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. Case Follow-up: The patient required benzodiazepine administration for seizure management and subsequent intubation for airway protection. Millions are poisoned, and hundreds of thousands die each year worldwide. 8 Figure 1.

Poisoning 81

Poisoning Airway Management Seizures PPE 81

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

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 84

Sepsis Administration Documentation/Coding Fractures 84

ALiEM

NOVEMBER 15, 2023

1,6,7] Dizziness, confusion, headache Shortness of breath Weakness and malaise Nausea and vomiting Hypotension, seizures, coma, apnea, arrhythmias Death due to cardiorespiratory arrest How do you diagnose cyanide poisoning? [7] What are the symptoms of cyanide poisoning?

Poisoning 67

Poisoning Pediatrics Seizures Administration 67

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). PPI administration to decrease gastric acid secretion. 5 Consider antifungal administration.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

Northwestern EM Blog

MARCH 28, 2022

Clinical Findings of Methanol Poisoning CNS sedation Seizures Rapid, Deep Breathing Hypotension Ocular findings: Blindness Afferent pupillary defect Optic disk hyperemia Mydriasis Ethylene Glycol Toxicity Similarly, the toxic metabolites of ethylene glycol cause end-organ damage at levels greater than 20mg/dl.

Poisoning 52

Poisoning Seizures Administration Pediatrics 52

RebelEM

OCTOBER 5, 2022

mg/dL 10.5 – 12.0 mg/dL 10.5 – 12.0

Dehydration 52

Dehydration Psychiatric Administration EKG/ECG 52

PulmCCM

OCTOBER 23, 2023

Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin.

Hospitals 98

Hospitals Emergency Department COPD CDC 98

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

ALiEM

AUGUST 16, 2023

Dyspnea Headache Syncope Coma Seizures How can you diagnose methemoglobinemia? Adverse Effects of Methylene Blue Pain at infusion site Blue discoloration of urine and serum Interferes with pulse oximetry, resulting in falsely low readings after administration. Interference with laboratory studies that use light absorption.

Poisoning 52

Poisoning Seizures Administration Pediatrics 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.

Seizures 245

Seizures Pediatrics CDC Infectious Diseases 245

RebelEM

SEPTEMBER 7, 2023

Levetiracetam is frequently used to prevent seizures in patients with conditions such as ICH, traumatic brain injury (TBI), supratentorial neurosurgery, and subarachnoid hemorrhage (SAH). About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ). Article : Peter-Derex et al.

Seizures 107

Seizures Stroke Outcomes Research 107

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., References Lulla A, et al.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Both of these also cause seizures. Here is the history : Male in 40's who had seizures and was unconscious. Second , if the patient is hemodynamically stable, without pulmonary edema, it may be wise to try some fluids and and benzodiazepines and/or propofol for this post-seizure patient with likely high catecholamine levels.

Seizures 52

Seizures Administration Outcomes Hospitals 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Four Components to Successful Pain Management and Intranasal Medication Administration Right drug, right dose, right patient, right timing Right Drug – Not every medication is easily amenable to intranasal administration. Intranasal Fentanyl Safe, effective at 2 mcg/kg. Most commonly stocked concentration of fentanyl is 50 mcg/mL.

Administration 40

Administration Seizures Emergency Department Ultrasounds 40

EMDocs

JANUARY 29, 2024

hypertensive emergency, need for thrombolytic administration) [1]. Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes.

Stroke 71

Stroke Outcomes EMS Seizures 71

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.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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

EMDocs

JULY 19, 2023

Further, organic mercury readily crosses the placenta where it acts as a teratogen leading to a wide range of birth defects including developmental delay, blindness, seizures, and limb malformation. Food and Drug Administration. Food and Drug Administration. Resources: S. 2022, February 25). 2018, February 1).

Poisoning 65

Poisoning Fluid Resuscitation Administration Seizures 65

Taming the SRU

JUNE 6, 2023

HAJDU Mild TBI’s & Concussions in the Emergency Department TBI’s are relatively common >3 million TBI’s in the US annually 2.5 million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 59

Documentation/Coding Seizures Wellness Psychiatric 59

EMDocs

AUGUST 17, 2023

The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 65

Sepsis Shock Resuscitation Fluid Resuscitation 65

EMDocs

AUGUST 3, 2023

IV is usually recommended due to faster onset, ease of administration, and shorter protocol duration. Massive acetylcysteine overdose associated with cerebral edema and seizures. In vitro analysis of N-Acetylcysteine (NAC) interference with the International Normalized Ratio (INR). Clinical Toxicology , 60 (4), 489–492. PMID: 21740141.

Poisoning 80

Poisoning Seizures Administration Pediatrics 80

EMDocs

MARCH 11, 2024

Oral antibiotic administration should take place for patients with severe cholera infection as soon as they are able to tolerate oral intake, which usually occurs after rehydration and administration of antiemetics. Among children, hypoglycemia is common and can lead to seizures.

Dehydration 87

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 87