Test Your Knowledge: Seizures in Neonates
June 29, 2020


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Neonatal seizures are associated with high morbidity and mortality, but they can be difficult to diagnose because they often present with subtle signs and symptoms. Our June issue, Seizures in Neonates: Diagnosis and Management in the Emergency Department, reviews common presentations and causes of neonatal seizures, considerations for emergency department management, and more. read more

What’s Your Diagnosis? Seizures in Neonates: Diagnosis and Management in the Emergency Department
May 29, 2020


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Welcome to this month’s What’s Your Diagnosis Challenge!

Case Presentation: Seizures in Neonates: Diagnosis and Management in the Emergency Department read more

What’s Your Diagnosis? An Evidence-Based Approach to Abnormal Vision
March 25, 2020


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 2 comments

Welcome to this month’s What’s Your Diagnosis Challenge!

Case Presentation: An Evidence-Based Approach to Abnormal Vision

A 40-year-old woman is brought in to the ED by her husband, complaining of blurred vision and dizziness. She said she had visited an urgent care clinic last week with a new diagnosis of migraine headache. Her examination is remarkable for right eyelid ptosis, limited movement of the right eye to left gaze, and a right dilated pupil compared to the left. read more

Risk Management Pitfalls in the Management of Pediatric Patients With Bacterial Meningitis
March 19, 2020


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The presentation of bacterial meningitis can overlap with viral meningitis and other conditions, and emergency clinicians must remain vigilant to avoid delaying treatment for a child with bacterial meningitis. Inflammatory markers, such as procalcitonin, in the serum and cerebrospinal fluid may help distinguish between bacterial meningitis and viral meningitis. Appropriate early antibiotic treatment and management for bacterial meningitis is critical for optimal outcomes. Although debated, corticosteroids should be considered in certain cases. read more

Test Your Knowledge: Evaluation and Management of Life-Threatening Headaches in the ED
February 6, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Emergency Medicine Practice Blog Brain Teaser

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively. read more

What’s Your Diagnosis? Patient With Acute Dizziness
November 29, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 3 comments

But before we begin, check out if you got last month’s case, on Pain Management: Beyond Opioids, right. Click here to check out the answer! read more

Test Your Knowledge: Nonconvulsive Status Epilepticus in the ED
October 3, 2019


Posted by Andy Jagoda, MD in: Brain Tease , add a comment

Nonconvulsive status epilepticus (NCSE) is characterized by persistent change in mental status from baseline lasting more than 5 minutes, generally with epileptiform activity seen on EEG monitoring and subtle or no motor abnormalities. NCSE can be a difficult diagnosis to make in the emergency department setting, but the key to diagnosis is a high index of suspicion coupled with rapid initiation of continuous EEG and early involvement of neurology.

When a patient presents to the ED with new-onset altered mental status or unusual behavior without visible convulsive activity, how can you tell if it is nonconvulsive status epilepticus?

Can you get it right?

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Check out the issue on Nonconvulsive Status Epilepticus: Overlooked and Undertreated (Pharmacology CME) to brush up on the subject.

Plus earn CME for this topic by purchasing this issue read more

What’s Your Diagnosis? Nonconvulsive Status Epilepticus: Overlooked and Undertreated
September 30, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 1 comment so far

But before we begin, check out if you got last month’s case, on assistance with air travel emergencies, right. Click here to check out the answer! read more

Intravenous Thrombolysis in Acute Ischemic Stroke
July 17, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Stroke is the fifth leading cause of death in the United States and an important cause of long-term disability. Approximately 795,000 people suffer from stroke each year (610,000 primary strokes and 185,000 recurrent strokes),1 with ischemic stroke representing the vast majority of all stroke types (87%).

The cornerstone of acute ischemic stroke treatment relies on rapid clearance of an offending thrombus in the cerebrovascular system. Advanced neuroimaging and clinical trials, together with continuous adjustments of inclusion/exclusion criteria, have helped emergency clinicians to rapidly and more accurately identify the patients who will benefit from acute stroke treatment.

Inclusion and Exclusion of Intravenous Thrombolysis: A Changing Landscape

The American Heart Association (AHA) recently published updated guidelines for stroke management. Table 1, summarizes the updated 2018 AHA indications and contraindications for treatment with IVT. Every patient presenting with symptoms of acute stroke within 4.5 hours of last known well or usual state should be triaged for potential IVT. Patients should be evaluated with computed tomography (CT) scan of the brain and systolic blood pressure (SBP) should be maintained at < 185 mm Hg and diastolic blood pressure (DBP) at < 110 mm Hg. Every eligible patient should receive IVT without delay. Changes and adjustments of inclusion/exclusion criteria (in order to minimize the risk of any complication) have been made and are discussed in following sections.

Table 1. Eligibility Criteria and Exclusion Criteria for Intravenous Thrombolysis
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May is Trauma Awareness Month!
May 16, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Clinical Pathway For Management In The Emergency Department Of Pediatric Patients With Suspected Cervical Spinal Cord Injury read more