Seizure Management
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Seizure Management in the Emergency Department (Pharmacology CME)

This resource, delivered fully online, includes two courses and one video session reviewing the evaluation and management of seizures in adult and pediatric patients, including neonates, for whom seizures can be difficult to diagnose. Presentations, diagnostic studies, and treatment options are discussed for different types of seizures, with particular emphasis on nonconvulsive status epilepticus. Includes 8.5 AMA PRA Category 1 Credits™, including 5.5 pharmacology credits.

Modules

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Authors

Annalee Morgan Baker, MD, FACEP
Assistant Professor of Emergency Medicine & Critical Care, Florida International University, Miami, FL; Clinical Assistant Professor of Emergency Medicine, NYU, New York, NY; Clerkship Director, Emergency Medicine, Aventura Hospital & Medical Center, Aventura, FL
Matthew Amir Yasavolian, MD
Attending Physician, Memorial Regional Hospital, Hollywood, FL
Navid Reza Arandi, MD
Attending Physician, Southern California Permanente Medical Group, Department of Emergency Medicine, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA
Melissa L. Langhan, MD, MHS, FAAP
Associate Professor, Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
Brielle Stanton, MD
Yale New Haven Children’s Hospital, New Haven, CT

Peer Reviewers

Cappi Lay, MD
Assistant Professor of Emergency Medicine and Neurocritical Care, Icahn School of Medicine at Mount Sinai, New York, NY
Elaine Rabin, MD
Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Felipe Teran, MD, MSCE
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Kyle B. Walsh, MD, MS
Assistant Professor, Department of Emergency Medicine, Neurointensivist and Stroke Team Member, University of Cincinnati, Cincinnati, OH
Nicole Gerber, MD
Assistant Professor of Clinical Pediatrics, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
Quyen Luc, MD
Clinical Assistant Professor of Neurology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA

Video Presenter

Andy Jagoda, MD, FACEP
Professor and Chair Emeritus, Department of Emergency Medicine; Director, Center for Emergency Medicine Education and Research, Icahn School of Medicine at Mount Sinai, New York, NY

Product Details

Publication Date: October 1, 2020

CME Expiration Date: October 31, 2022

CME Information: Included as part of the 8.5 credits, this CME activity is eligible for 5 Pharmacology CME credits, subject to your state and institutional approval. Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME. Credit Designation: EB Medicine designates this enduring material for a maximum of 8.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The Seizure Management in the Emergency Department course is eligible for 8 Category 2-A or 2-B credit hours by the American Osteopathic Association. The “Nonconvulsive Status Epilepticus: Overlooked and Undertreated” journal issue of Seizure Management in the Emergency Department is approved by the American College of Emergency Physicians for 4 Category I credits. The “Seizures in Neonates: Diagnosis and Management in the Emergency Department” journal issue of Seizure Management in the Emergency Department is approved by the American College of Emergency Physicians for 4 Category I credits, and has been reviewed by the American Academy of Pediatrics and is acceptable for 4 AAP credits.

Table of Contents

Course 1: Nonconvulsive Status Epilepticus: Overlooked and Undertreated + EMplify podcast audio summary

  1. Abstract
  2. Case Presentations
  3. Abbreviations of Types of Status Epilepticus
  4. Introduction
  5. Classification and Taxonomy of Status Epilepticus
  6. Critical Appraisal of the Literature
  7. Etiology and Pathophysiology
  8. Differential Diagnosis
  9. Prehospital Care
  10. Emergency Department Evaluation
    1. History
    2. Physical Examination
  11. Diagnostic Studies
    1. Laboratory Studies
    2. Neuroimaging
    3. Lumbar Puncture
    4. Electroencephalography
  12. Treatment
    1. Pharmacologic Therapy
      1. First-Line Treatment
      2. Second-Line Treatment
      3. Third-Line Treatment
  13. Special Populations
    1. Patients Abusing Alcohol
    2. Elderly Patients
  14. Controversies and Cutting Edge
    1. Bedside Electroencephalography
    2. Additional Treatment Options
  15. Disposition
  16. Summary
  17. Time- and Cost-Effective Strategies
  18. Risk Management Pitfalls for Patients With Nonconvulsive Status Epilepticus in the Emergency Department
  19. Case Conclusions
  20. Clinical Pathway for Management of Nonconvulsive Status Epilepticus
  21. Tables
    1. Table 1. Clinical Features of Nonconvulsive Status Epilepticus
    2. Table 2. Clinical Subtypes and Features of Nonconvulsive Status Epilepticus
    3. Table 3. Common Etiologies of Nonconvulsive Status Epilepticus
    4. Table 4. Differential Diagnosis for Nonconvulsive Status Epilepticus
    5. Table 5. Clinical Findings and Risk Factors in Nonconvulsive Status Epilepticus
    6. Table 6. Treatment Approach in Nonconvulsive Status Epilepticus, by Subtype
    7. Table 7. Pharmacotherapy for Nonconvulsive Status Epilepticus
    8. Table 8. Indications for Continuous EEG to Diagnose Nonconvulsive Status Epilepticus in the Critically Ill Patient
  22. References

Course 2: Seizures in Neonates: Diagnosis and Management in the Emergency Department

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology
    1. Infectious Etiologies
    2. Vascular Etiologies
    3. Metabolic Etiologies
      1. Inborn Errors of Metabolism
    4. Other Etiologies
    5. Timeline for Seizure Onset
  6. Differential Diagnosis
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. Initial Stabilization
    2. History
    3. Physical Examination
  9. Diagnostic Studies
    1. Laboratory Studies
    2. Imaging Studies
    3. Electroencephalography
  10. Treatment
    1. Antiepileptic Drugs
      1. Phenobarbital
      2. Phenytoin/Fosphenytoin
      3. Levetiracetam
      4. Benzodiazepines
      5. Lidocaine
      6. Other Antiepileptic Drugs
    2. Non–Antiepileptic-Drug Management
  11. Special Populations
    1. Premature Neonates
    2. Patients With Recurrent Brief Resolved Unexplained Events
    3. Patients Who Have Not Had Standard Prenatal Care/Patients With Risk of Exposure to Infectious Agents
    4. Patients Born Outside a Medical Facility
  12. Controversies and Cutting Edge
    1. Medication Choices
    2. Amplitude-Integrated Electroencephalography
    3. Genetic Testing
  13. Disposition
  14. Summary
  15. Time- and Cost-Effective Strategies
  16. Risk Management Pitfalls for Neonatal Seizures
  17. Case Conclusions
  18. Clinical Pathway for Management of Neonatal Seizures
  19. Tables and Figures
    1. Table 1. Risk Factors for Neonatal Seizures
    2. Table 2. Seizure Etiologies
    3. Table 3. Antiepileptic Drugs
    4. Table 4. Medications to Correct Metabolic Derangements
    5. Figure 1. Seizure Onset Timeline: Seizure Etiology By Postnatal Age
  20. References

 

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