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

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 86

Infectious Diseases Seizures Ultrasounds Sepsis 86

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

EMDocs

JULY 3, 2023

4 Common symptoms of SAH on presentation include vomiting, neck stiffness, altered mental status or decreased level of consciousness, hemiparesis, and seizure-like activity. 18 Seizure Seizure is common in the setting of acute SAH, especially spontaneous SAH, due to cerebral and meningeal irritation.

Seizures 83

Seizures Stroke Outcomes EMS 83

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

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

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.

EKG/ECG 97

EKG/ECG Seizures Wellness EMS 97

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

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

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.

Poisoning 92

Poisoning Hyperthermia / Hypothermia Seizures Administration 92

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

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

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

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.

Seizures 67

Seizures Academics Wellness 67

Critical Care Now

JUNE 21, 2022

His coach and fellow players witnessed a seizure-like activity immediately after collapsing. CPVT is a difficult diagnosis to make during a routine clinic visit and can be easily misdiagnosed as vasovagal syncope or a seizure disorder. Other beta-blockers can be used here as well. -It

Seizures 52

Seizures EKG/ECG CPR Shock 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.

Seizures 40

Seizures Wellness Hospitals 40

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

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.

Pediatrics 128

Pediatrics Wellness Seizures Resuscitation 128

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

Pediatric Education

APRIL 28, 2024

“I’m happy that she is continuing to progress and the physical therapist thinks she will do very well. The pediatrician asked if the parent had any questions about the cerebral palsy diagnosis and the mother said that she had thought she had a problem, but the neonatologist had confirmed it.

Seizures 40

Seizures Pediatrics Dislocations Stroke 40

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

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

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. 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. This was made by people who know them very well. And you’re thinking, hey!

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 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.”

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Pediatric Education

MARCH 3, 2024

The placenta doesn’t work very well causing problems for mom and baby. The baby doesn’t grow very well so that causes a host of problems including abnormal glucoses. In my experience, small babies don’t feed as well. Eclampsia is a severe complication of pre-eclampsia that has new onset seizures.

Wellness 40

Wellness Pediatrics Seizures Stroke 40

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.

Pediatrics 68

Pediatrics Ultrasounds Wellness Fractures 68

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!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Pediatric EM Morsels

AUGUST 18, 2023

Myth # 2: Neurologic affects Nervous system adverse events mostly include central concerns (ex, seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. So, in the right clinical situtation, the benefits of the fluoroquinolone use in children may outweigh the risk.

Pediatrics 130

Pediatrics Infectious Diseases Hospitals Seizures 130

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

Pediatrics 161

Pediatrics CDC Seizures Infectious Diseases 161

EMDocs

JUNE 14, 2023

This leads to an enhanced, as well as a prolonged predominant cholinergic effect. Used for treatment of acutely symptomatic anxiety, muscle fasciculations, and seizures. Farmers treating sheep for parasites may be symptomatic after exposure, an illness called Dipper’s Flu. 1 Avoid cholinergic agents that will exacerbate symptoms.

PPE 68

PPE Poisoning Seizures Emergency Department 68

ACEP Now

APRIL 2, 2024

1 In severe cases altered mental status, seizures, coma, or even death have been observed. Francis Hospital and Medical Center, as well as an assistant professor at University of Connecticut School of Medicine and Quinnipiac University School of Medicine. Franco is an emergency medicine attending physician at St.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40

RebelEM

NOVEMBER 16, 2022

MetHb < 25% with symptoms Abnormal vital signs Metabolic acidosis End organ dysfunction (i.e.

Seizures 52

Seizures Administration Airway Management COPD 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). Caution with use of NIPPV – positive pressure can worsen injury as well as increase subcutaneous emphysema.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

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

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

Sensible Medicine

JUNE 30, 2023

On the other hand, KW was a middle-aged American man with chest pain and significant risk factors for coronary artery disease – hypertension and diabetes – neither of which had ever been terribly well-controlled. She was well hydrated and her vital signs were normal. PH is a woman I have written about in the past.

Hospitals 91

Hospitals Hospice Resuscitation COPD 91