RebelEM

SEPTEMBER 27, 2023

If QRS >100 msec = 33% chance of seizures If QRS >160 msec = 50% of ventricular dysrhythmias Often extrapolated to other sodium channel blocking agents: diphenhydramine, loperamide, cocaine, lamotrigine, Type 1A/1C Anti-Dysrhythmics. As a result, it is essential to replete potassium simultaneously. N Engl J Med. PMID: 4022081.

Poisoning 85

Poisoning Seizures Administration EKG/ECG 85

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

Dr. Smith's ECG Blog

MARCH 11, 2012

A young man presented after a prolonged seizure. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Approach to Wide Complex Tachycardia Unstable – Shock it 12-lead if at all possible --Unstable defined by : Chest Pain Shock Hypotension Very dyspneic Pulmonary Edema Stable Get a 12-lead ECG Sinus?

Seizures 52

Seizures Shock EKG/ECG Outcomes 52

Critical Care Now

JUNE 21, 2022

His coach and fellow players witnessed a seizure-like activity immediately after collapsing. Paramedics continued chest compressions, gave epinephrine via an intraosseous route, and delivered one shock. CPR was started immediately after the coaching staff could not find a pulse and EMS arrived to find the patient in cardiac arrest.

Seizures 52

Seizures EKG/ECG CPR Shock 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

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Will treating with antipyretics prevent a febrile seizure? Critical Care Medicine 2017.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

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

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

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). upper endoscopy, transesophageal echo, etc.). 4 Fluid resuscitation and vasopressor use as appropriate.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

Dr. Smith's ECG Blog

JUNE 26, 2023

Most occurrences are associated with events such as sepsis, shock, recent infarction, post-operative state, electrolyte disturbance — or "sick patient". Seizure activity was witnessed at the scene — and head CT scan showed a small bleed. PEARL # 5: Accelerated junctional rhythms are not common in adults.

EKG/ECG 75

EKG/ECG Seizures Sepsis Operations 75

Mount Sinai EM

AUGUST 20, 2023

If seizures , treat with usual benzodiazepines. Hypoxemia, hypercarbia and acidosis worsen the toxicity. Establish 2 IV access. Patient should already be on a monitor. If hypotension , give small doses of epinephrine (1 mcg/kg bolus). Avoid phenylephrine and vasopressin. Lorazepam 2-4 mg/IV or Midazolam 10 mg/IM.

Seizures 243

Seizures Shock Outcomes 243

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

Downeast Emergency Medicine

APRIL 26, 2021

We know that if administered too rapidly, it can lead to hypotension and other adverse effects including seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired color vision, and other visual disturbances.[1] Lastly, the use of TXA is not without risk.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). Jenkins and Frick — or additional procedures may be ordered and/or patients shocked for artifact simulating VT/VFib ). The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

EKG/ECG 61

EKG/ECG Wellness Point-of-Care Testing Shock 61

Dr. Smith's ECG Blog

MARCH 30, 2014

They were worried that the syncope was seizure and that she had brain mets. Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Cardiologist note says: "Elevated troponin explained by type II MI due to her shock." Previous ECG. The lactate was elevated and pH low.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

Taming the SRU

APRIL 13, 2023

EtOH, amphetamines, or cocaine) Prescription drugs (i.e. beta blockers decrease ability to dissipate heat through increase CO, diuretics predispose to dehydration, or anticholinergic agents can affect thermoregulation) Clinical Presentation: Temperature elevation, usually 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

JULY 14, 2010

Before EMS arrived, she had "seizure activity" and became unresponsive. She arrived comatose and in cardiogenic shock and the following ECG was recorded. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She was intubated.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 52

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent.

Seizures 65

Seizures EKG/ECG Poisoning Shock 65

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients.

Poisoning 129

Poisoning Airway Management Seizures Shock 129

Taming the SRU

SEPTEMBER 24, 2023

Patients with a history of seizures, supratentorial structural brain pathologies, post-arrest, or unexplained altered mental status should prompt suspicion for NCSE. However, Ceribell is a useful technology to help detect seizure activity and affect disposition. Two main theories behind the development of PRES. (1)

Seizures 52

Seizures EKG/ECG Emergency Department Shock 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% I will continue to reach for pressors early in resuscitation of the septic shock patient.

Sepsis 65

Sepsis Shock Resuscitation Fluid Resuscitation 65

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 The rhabdo is believed to be due, in part, to associated seizures, muscle tremors, and agitation. Symptoms here include irritability, anxiety, restlessness, sleep difficulty, seizures, and aggression.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

HELLP Syndrome [pdf] Sara Paul MD Intrauterine Fetal Demise [ppt] Irene Hwang, MD Obesity in Pregnancy [pdf] Rafael Garabis, MD Seizures in Pregnancy [ppt] Sherifia Heron , MD Substance Abuse in Pregnancy [ppt] Sophia Y. Journal of Emergencies, Trauma and Shock, 3(1), 39. Episiotomy [ppt] Alice Teich, MD. Capriola, M.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. 18 Patients with signs and symptoms of severe dehydration or shock, including stupor, coma, uncontrollable vomiting, extreme fatigue that prevents drinking, and unstable vital signs should receive IV fluid resuscitation.

Dehydration 87

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 87

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

DECEMBER 16, 2023

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. Clinical decision making in seizures and status epilepticus. Updated 2022 Oct 24].

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

Don't Forget the Bubbles

JULY 26, 2023

Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Mind The Bleep

DECEMBER 16, 2023

Findings may include: Leukopaenia Thrombocytopaenia (nearly always present, and not predictive of severity) Anaemia Severe malaria is defined as any of the following: Shock (BP <90/60) AKI, oliguria, or haemoglobinuria (“Blackwater fever”) Reduced GCS/coma/seizure Acidosis Hypoglycaemia Hb <80g/L DIC/spontaneous bleeding Pulmonary oedema/ARDS (..)

Rapid Diagnostic Testing 52

Rapid Diagnostic Testing Infectious Diseases Best Practices Seizures 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. Still Irregular Blood pressure during these rhythms was adequate; there was no shock. Alternatively , it is someone who has an old myocardial infarction and is now very sick with something else.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

Meanwhile, the patient has just returned from a scan and had a seizure in front of you because his brain is speckled with contrast; post-ictus, he's apneic despite airway measures, and now one must give mouth-to-mouth because there's no bag at the bedside … see what I mean? Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Implantable Cardioverter-Defibrillator ), with long-term potential for device-related complications from the ICD, including inappropriate shocks?

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric Emergency Playbook

JUNE 1, 2017

The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Suryawanshi SP. Ann Emerg Med.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Do not use pethidine since it can cause seizures and CNS hyperexcitability. coli and Staphylococcus aureus. What strategies can be implemented to prevent infections in the asplenic patient?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. CTA head/neck is absolutely indicated if suspicion is high for this condition. 46 All of these states are some gradation of consciousness impairment. IgE-mediated reactions to contrast do exist, but they are very rare.

Stroke 84

Stroke Radiology Radiology Emergency Department 84