EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Check glucose, obtain imaging, stop the seizure. They administer two doses of 10 mg midazolam IM.

Seizures 71

Seizures Documentation/Coding EKG/ECG Emergency Department 71

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

EMergucate

SEPTEMBER 14, 2022

A 64 year old male presents to ED after multiple seizure episodes that day. It was reported that the patient would have 20 seconds of seizure activity and then make a full recovering. The patient h…

Seizures 52

Seizures EKG/ECG 52

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

RebelEM

SEPTEMBER 27, 2023

REBEL Core Cast 109.0 – Na Channel Blocker Poisoning Click here for Direct Download of the Podcast Definition and Physiology Standard definition of a wide QRS is anything > 120 msec (3 small boxes on the ECG) In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. Boehnert 1985 ). N Engl J Med.

Poisoning 85

Poisoning Seizures Administration EKG/ECG 85

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). Editorial Comment : Yes to PCI after arrest with STEMI on ECG. Treatment of nonconvulsive seizures (diagnosed by EEG only) is reasonable in adult survivors of cardiac arrest.

Seizures 80

Seizures Shock CPR Hyperthermia / Hypothermia 80

EMergucate

SEPTEMBER 13, 2022

A 64 year old male presents to ED after multiple seizure episodes that day. It was reported that the patient would have 20 seconds of seizure activity and then make a full recovering. The patient h…

Seizures 40

Seizures EKG/ECG 40

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 73

Seizures Shock Infectious Diseases CPR 73

EMDocs

APRIL 10, 2024

She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. 1,5] CNS symptoms include: Seizure, coma, altered mental status. [1] 1-3,5,7,9] All patients developing symptoms of LAST should be placed on a continuous cardiac monitor and have an ECG performed. [2]

Advances Cardiac Life Support (ACLS) 91

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 91

Critical Care Now

JUNE 21, 2022

His coach and fellow players witnessed a seizure-like activity immediately after collapsing. The first prehospital EKG showed Polymorphic Ventricular Tachycardia (PVT) that responded to defibrillation. A normal baseline EKG (if obtained while at rest) will exclude conditions like short or long QT syndromes, Brugada or WPW.

Seizures 52

Seizures EKG/ECG CPR Shock 52

Emergency Medicine Cases

AUGUST 2, 2022

David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions. We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure?

Seizures 52

Seizures EKG/ECG EMS 52

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

EB Medicine

JUNE 1, 2021

Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Glucose ECG ED History - table 4 History of similar Prodrome Associated symptoms (chest pain, neuro symptoms, etc) Falls Pre-syncope ? ECG Brugada, blocks, VT, ST changes, etc Labs BNP, delta bnp ?

Seizures 52

Seizures Emergency Department EKG/ECG Hospitals 52

Dr. Smith's ECG Blog

MARCH 19, 2019

This patient presented with weakness, decreased urine output, and vomiting: What is the ECG diagnosis? Here was a repeat ECG: QTc 523. The value of recognizing this particular ECG pattern — is that it may expedite your clinical diagnosis even before laboratory results return. This is pathognomonic for hypocalcemia.

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

Taming the SRU

JANUARY 26, 2024

Yates Case 1: Stroke and Stroke Mimics Early diagnosis of stroke improves stroke outcomes, where misdiagnosis is associated with an upwards of 4-time higher likelihood of mortality Missed strokes most often occur with atypical symptoms, in younger aged patients, those with posterior strokes, and those with lower NIH scores It can be difficult to discern (..)

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

Dr. Smith's ECG Blog

JANUARY 21, 2023

The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. ECG met STEMI criteria and was labeled STEMI by computer interpretation. ECG met STEMI criteria and was labeled STEMI by computer interpretation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Dr. Smith's ECG Blog

MARCH 11, 2012

A young man presented after a prolonged seizure. Here was his initial ECG: Regular Wide Complex Tachycardia. Here is the same ECG with some annotation (lines): The first line is drawn at the onset of the QRS in V2, which is clear. Here is the subsequent ECG: This is clearly sinus tach. The patient was unconscious.

Seizures 52

Seizures Shock EKG/ECG Outcomes 52

Taming the SRU

MARCH 17, 2023

mepivacaine (1-3 h) 1% lidocaine +/- epi (2-3h) 0.25% bupivacaine (2-3 h) 0.25-0.5% mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

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

EB Medicine

MARCH 7, 2022

Fever and infection (labs, imaging – US or CT, antibiotics) Cardiopulmonary complaints (labs, imaging, ECG) 11.Treatment Treatment Hemorrhage Headache (CVT) Infection (mastitis, endometritis, wound Infection) Preeclampsia, eclampsia, HELLP, seizures Cardiomyopathy 12.What What about breastfeeding mothers?

Emergency Department 52

Emergency Department Seizures EMS EKG/ECG 52

Dr. Smith's ECG Blog

JUNE 26, 2023

Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). As I discuss in detail in My Comment at the bottom of the page in the May 24, 2020 post in Dr. Smith's ECG Blog — AV dissociation is not the same as AV block. How would YOU interpret this tracing?

EKG/ECG 75

EKG/ECG Seizures Sepsis Operations 75

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

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 80

Stroke EKG/ECG Seizures CPR 80

EMDocs

JANUARY 17, 2024

Her electrocardiogram (ECG) showed atrial fibrillation which was cardioverted to sinus rhythm. Benzodiazepines are first-line therapy for seizures. Interventions are supportive including benzodiazepines for seizures, sodium bicarbonate for prolonged QRS and arrhythmias, and intravenous lipid emulsion for cardiac arrest.

Poisoning 66

Poisoning Seizures Pediatrics Administration 66

ECG Guru

AUGUST 2, 2023

His brother was diagnosed epilepsy and died during a seizure at the age of 21. This patient is a 50-year-old man. Parts of the following text i have taken over from Dawn`s explanation on Brugada pattern/Brugada syndrome:

Seizures 52

Seizures 52

Mind The Bleep

MAY 16, 2023

Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI. Other tests: At most, guidelines suggest that an ECG and pertussis test may be undertaken. An event cannot be said to be unexplained unless you have tried to explain it.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

Pediatric EM Morsels

MAY 10, 2024

Add the risk assessment for sudden cardiac death into your workflow Have you ever fainted or had a seizure without warning, during exercise or in response to a loud noise? EKG Reasonable screen for cardiac etiology [ Kane, 2010 ]: Chest Pain with Exertion? Have you ever had chest pain or shortness of breath in exercise?

EKG/ECG 203

EKG/ECG Pediatrics Ultrasounds Seizures 203

Dr. Smith's ECG Blog

MARCH 30, 2014

The minute this medical student saw the first ECG, he knew the diagnosis without any further information. Reading ECGs is hard, but can be done with commitment to learning, which comes from an awareness of its importance. You need to be interested and understand the value of the ECG. She had this ECG recorded: ECG 1: QTc is 484.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

PEMBlog

MARCH 27, 2024

They include neurologic dysfunction, which is one of the most common that includes things like developmental delay, regression, AKA loss of developmental milestones, hypotonia, encephalopathy, or seizures. So they’re lethargic, they might vomit, they’re hypotonic, hypothermic, they might have fever or seizures.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Here is his triage ECG: What do you think? What is the most likely cause of the patient’s ECG findings, and what would be your first step in management? What does the ECG show? What does the ECG show? Figure-1: The initial ECG in this case — and a rapid method for estimating the QTc ( See text ). Is it STEMI?

EKG/ECG 100

EKG/ECG Seizures Hospitals Stroke 100

PEMBlog

SEPTEMBER 6, 2023

Life threatening non-psychiatric causes of acute psychosis include hypoglycemia, cerebral hypoxia, drug toxicity, CNS abnormalities (such as brain tumor, meningoencephalitis, injury, seizures, or stroke), metabolic conditions, electrolyte disturbances, hepatic failure, uremia, or thyrotoxicosis.

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52

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. EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Taming the SRU

MAY 1, 2023

Patients must have EKG findings and meet one of a few other criteria (ie family history of sudden death, VF or VT episode, syncope, nocturnal agonal respirations) Most common in patients of Southeast Asian descent and the mean age of death from arrhythmia if untreated is in the 4th decade of life.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Taming the SRU

FEBRUARY 23, 2024

Location of the block will determine the morphology of the QRS (as a higher block may have a narrow QRS with a rate of 40-60bpm) Evaluation in the ED: basic labs including BMP and troponin, EKG, bedside echo, CXR Management: Atropine: push-dose 0.5-1mg,

Pediatrics 68

Pediatrics Ultrasounds Wellness Fractures 68

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients.

Blood Transfusions 69

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 69