EMDocs

JANUARY 29, 2024

This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes. Ischemic Strokes: Ischemic stroke is characterized by a blockage of a blood vessel in the brain. The BP targets for patients with ischemic strokes depend on the available therapeutic options.

Stroke 71

Stroke Outcomes EMS Seizures 71

Taming the SRU

JANUARY 26, 2024

Morbidity & MOrtality - Mini Lit Blitz - Post-Rosc Care - Qi/KT Morbidity & Mortality WITH Dr. 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 (..)

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

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

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 66

Seizures Fractures EKG/ECG Resuscitation 66

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

Pediatric Education

FEBRUARY 18, 2024

There was no reported respiratory distress or problems handling secretions and no obvious seizure activity. Seizures, cerebrovascular problems and central nervous system tumor swirl in professionals’ heads as they take in the history, physical examination and start to evaluate and manage the problem. How are seizures classified?

Seizures 40

Seizures Pediatrics Psychiatric Radiology 40

Emergency Medicine Cases

SEPTEMBER 12, 2023

The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.

EKG/ECG 114

EKG/ECG Seizures Stroke EMS 114

Taming the SRU

FEBRUARY 5, 2024

As may be seen in the table below, there are several themes as well a range of stringency. Find the posterior superior iliac crest and draw an imaginary line across the back (Tuffier’s line) – where this line crosses midline is the L4 spinous process.

Infectious Diseases 86

Infectious Diseases Seizures Ultrasounds Sepsis 86

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

Don't Forget the Bubbles

JUNE 30, 2023

Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. As in CRASH-2, TXA did not show a significant increase in thrombotic events or seizures. 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

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

Pediatric Education

APRIL 28, 2024

Historically it was made after age 12 months, but can be made before 6 months.

Seizures 40

Seizures Pediatrics Dislocations Stroke 40

EMDocs

MAY 15, 2024

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.

Blood Transfusions 69

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 69

Pediatric Education

MARCH 3, 2024

Eclampsia is a severe complication of pre-eclampsia that has new onset seizures. Long term, infants have higher risks of hypertension, stroke and increased body mass index. .” Estimate are between 1 – 5.6% of pregnancies have pre-eclampsia. Pre-eclampsia classification is based on symptoms.

Wellness 40

Wellness Pediatrics Seizures Stroke 40

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

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ).

Seizures 107

Seizures Stroke Outcomes Research 107

Pediatric Emergency Playbook

MAY 1, 2016

For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke). sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. V – Vascular (e.g.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

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

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

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] MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Also used for severe MS, stroke, TBI, chronic pain. Vagus nerve stimulation for partial seizures. Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine. Verify the medication and identify the toxidrome if symptomatic.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

Sensible Medicine

JUNE 30, 2023

By the time she died, this management had included intravenous fluids, pain medications, antiemetics, and seizure medications. There was fatigue, weight loss, nausea, declining kidney function, and a few strokes. I managed her evaluation and her care while she remained an outpatient. She was in her late 70’s and she was dying.

Hospitals 91

Hospitals Hospice Resuscitation COPD 91

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

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.,

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

ACEP Now

APRIL 2, 2024

8 Seizures and thunderclap headache from reversible cerebral vasoconstriction syndrome have been reported. 8,9 There is one case of a 17-year-old who died from acute cerebellar stroke after participating in the “One Chip Challenge” (eating a capsaicin infused food chip as a game) that prompted Hershey Co. to recall the product.

Burns 40

Burns Poisoning Seizures Stroke 40

Dr. Smith's ECG Blog

MARCH 19, 2019

Think of : i ) Drugs ( many drugs prolong the QT interval — and combinations of drugs may result in marked prolongation ) ; ii ) “ Lytes ” ( ie, Think of low K+ — low Mg++ — and / or — low Ca++ ) ; and , iii ) a CNS Catastrophe ( ie, stroke, bleed, coma, seizure, trauma, brain tumor ).

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

EMDocs

DECEMBER 16, 2023

As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C.

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

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. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 84

Sepsis Administration Documentation/Coding Fractures 84

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

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 100

EKG/ECG Seizures Hospitals Stroke 100

Taming the SRU

JUNE 6, 2023

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

The Skeptics' Guide to EM

DECEMBER 16, 2017

Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. It was a witnessed clonic-tonic seizure that stopped but he did not wake up. The paramedics report another seizure on route to the hospital. He then has another seizure in the department. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. Do not use pethidine since it can cause seizures and CNS hyperexcitability. What is the role of transcranial dopplers in primary prevention of strokes?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 84

Stroke Radiology Radiology Emergency Department 84

Dr. Smith's ECG Blog

AUGUST 13, 2020

He had a h/o ischemic cardiomyopathy and right MCA stroke. The patient was awake at this point, lactate was 7 mEq/L and so seizure was suspected as the etiology of the transient loss of consciousness and gaze deviation. The patient initially presented with a report of SOB prehospital, but this he denied.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

EB Medicine

FEBRUARY 1, 2019

Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Jeff: In terms of BP management, guidelines from the american stroke association recommend targeting a SBP of 160 with a titratable agent like nicardipine or clevidipine.

Emergency Department 40

Emergency Department Stroke Outcomes Wellness 40