seizure Archives - Emergency Medicine Cases

Ep 133 Emergency Management of Status Epilepticus

Among the presentations seen in the ED, few command the same respect as status epilepticus. It is, in itself, both a diagnostic dilemma and, at times, a therapeutic nightmare. There’s a reason it’s the very first domino to fall in the dreaded sequence “seizure, coma, death”. Status epilepticus can be nuanced to manage. Sure, most seizures self-abort or love an IV dose of lorazepam, but ask anyone who’s been down the propofol route, and they’re not likely to have forgotten the time they stared down a patient who just...would...not....stop...

By Anton Helman|2022-12-06T07:48:05-05:00December 17th, 2019|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology, Resuscitation|Tags: Dr. Aylin Reid, Dr. Paul Koblic, leviteracetam, lorazepam, seizure|3 Comments

EM Quick Hits 7 Approach to Status Epilepticus, Codeine Interactions, Anticoagulation in Malignancy, Atrial Fibrillation Rate vs Rhythm Control, Peripheral Vasopressors, Motivational Interviewing

Anand Swaminathan on a simple approach to status epilepticus, David Juurlink on codeine and tramadol interactions: nasty drugs with nastier drug interactions, Brit Long on DOACS in patients with malignancy: which patient's with cancer can be safely prescribed DOACs? Ian Stiell on atrial fibrillation rate vs rhythm control controversy, Justin Morgenstern on peripheral vasopressors: safe or unsafe? Michelle Klaiman, Taryn Lloyd on motivational interviewing that makes a difference to patient's lives...

By Anton Helman|2023-02-06T12:45:58-05:00August 13th, 2019|Categories: Cardiology, EM Cases, EM Quick Hits, Emergency Medicine, Neurology, Psychiatry, Resuscitation, Toxicology|Tags: anticoagulants, atrial fibirillation, codeine, Dr. David Juurlink, DVT, motivational interviewing, pain management, pulmonary embolism, seizure, status epilepticus, vasopressors|5 Comments

Best Case Ever 29: Drug Induced Aseptic Meningitis

Dr. David Carr presents his third of EM Cases' Carr's Cases. This series features potentially debilitating diagnoses that may be thought of as 'zebras', but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. Dr. Carr tells the story of young woman with an MRSA supra pateller abscess who was put on trimethoprim sulfamethoxazole and presents looking very ill with a severe headache. Not only has trimethoprim sulfamethoxazole been implicated in aseptic meningitis, but NSAIDS, immunomodulators and antibiotics have also been implicated. The reason this is so important for ED practitioners to know, is that case reports of drug-induced aseptic meningitis have shown that symptoms will resolve completely within 24 hours, once the offending drug has been stopped. Not only that, but if the patient receives the drug again in the future, they are at risk for a more severe case of drug induced aseptic meningitis.

By Anton Helman|2020-05-31T23:22:27-04:00September 23rd, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: altered mental status, Carr's Cases, David Carr, meningtitis, seizure|0 Comments

Best Case Ever 22: Nonconvulsive Status Epilepticus (NCSE)

In the first of our series on Best Case Ever of 'Carr's Cases' we have, the legend himself, Dr. David Carr. This series will run on the theme of interesting diagnoses that we don't think of too often, but that are not as rare as we might think and can make a significant difference to your patient's outcome if you pick up on them early - and maybe even make you look as smart as David! Dr. Carr will be highlighted in our upcoming episode on Whistler's Update in EM Conference highlights 2014 when he will be speaking about his approach to the shocky patient as well as the controversial management of submassive pulmonary embolism. He will be featured along with Dr. Lisa Thurgur speaking about lipid emulsion therapy and other toxicologic goodies and Joel Yaphe will give us his take on the best of the EM literature from 2013 including the TTM trial, tranexamic acid for epistaxis, return to sport after concussion guidelines and more. Please go to the 'Next Time on EM Cases' page to submit your question about these topics.

By Anton Helman|2017-02-05T14:30:29-05:00May 5th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology, Resuscitation|Tags: benzodiazepine, David Carr, epilepsy, found down, seizure, Whistler|0 Comments

Episode 27: Drugs of Abuse – Stimulants and Opiates

Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....

By Anton Helman|2021-03-31T13:05:16-04:00October 15th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Best Case Ever 12: Drugs of Abuse

As a bonus to Episode 27 on Drugs of Abuse -Stimulants & Opiates, Dr. Margaret Thompson, one of Canada's leading Toxicologists and the medical director of the Ontario Poison Control Centre tells us 2 of her Best Cases Ever about stimulant overdose surprises. In the related Episode, Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more.... [wpfilebase tag=file id=396 tpl=emc-play /] [wpfilebase tag=file id=397 tpl=emc-mp3 /]

By Anton Helman|2019-11-11T21:38:55-05:00October 7th, 2012|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Episode 13 Part 1: Killer Coma Cases – The Found Down Patient

In Part 1 of Killer Coma Cases - The Found Down Pateint, Dr. Helman presents two challenging cases to Dr. Brian Steinhart and Dr. David Carr, who tell us loads of key clinical pearls in their approaches to the 'found down' patient. They discuss the important components of the neurological exam in the comatose patient, the differential diagnosis of altered mental status and hyperthermia, the controversies around when to get a CT head before performing a lumbar puncture, and much more in this Killer Coma Cases episode. In Part 1 of this episode, we discuss the limitations of plain CT, the interpretation of CSF and the many faces of seizures. Any more information would be giving away the cases.....

By Anton Helman|2021-03-31T13:28:42-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: altered mental status, Brian Steinhart, coma cocktail, CSF analysis, David Carr, found down, lumbar puncture, meningitis, seizure, status epilepticus|5 Comments