Migraines are a common sight during any shift in the ED. I have written about them before, and the benefits of antiemetics and depakote are reasonably well documented. A treatment for refractory headaches that seems to be gaining favor recently is IV magnesium. You may be familiar with Mag and its use in asthma exacerbation, or (gasp) preeclampsia - but [...]
If you're a regular reader of the blog you know that I've posted on migraines before. For instance, you can check out the "Why We Do What We Do" on antiemetics (prochlorperazine and metoclopramide). Other excellent Pediatric Emergency Medicine educators have posted on the topic recently as well - see Sean Fox's recent post on PedEMMorsels. I wanted to take [...]
Continuing onward with the top ten articles presented at the recent AAP NCE in San Diego is a randomized control trial comparing lorazepam versus diazepam for pediatric status epilepticus. Links PubMed JAMA The bottom line Lorazepam and diazepam are equally efficacious and safe choices for the treatment of status epilepticus in pediatric patients. What they did The authors conducted a [...]
The pupils can be thought of as a window to the brain in patients with altered mental status. This brief video reviews some of the important findings that you should recognize.
Check out this brief lecture I recently gave on altered mental status. It reviews terminology, diagnosis and management and is designed as a broad overview to one of the most challenging issues to evaluate in the Pediatric Emergency Department.
Certainly we've all taken care of of the patient with the chief complaint "possible seizure." Upon history and examination many of us will discover that the patient had syncope. So, the purpose of this post is to examine how we differentiate between convulsions in a epileptic seizure versus those that occur when a patient faints. Read on! What actually happens [...]
In the ED we certainly see a significant number of head injuries. There are an estimated 1.7 million per year in the US. Fortunately most of these are not associated with intracranial bleeding. However, that certainly does not mean that there aren't important diagnoses to consider. Concussions have gained increased attention over the past decade thanks in part to a growing [...]
This edition of PEM Currents focuses on the use of antiemetics to treat status migrainosus in the Pediatric ED. Prochlorperazine and Metoclopramide are safe and effective agents with a low incidence of self limited side effects that when given in combination with ketorolac result in over 90% of patient being headache free at 3 hours. You can get it from [...]
In the Pediatric ED we encounter post-LP headache (PLPHA) less frequently than our colleagues who take care of grown ups. Nonetheless, it is an important topic to review. This post focuses specifically on caffeine, though before moving on to the not-quite Starbucks sponsored portion of the post it is a good idea to review PLPHA in general: The estimated incidence [...]
Many of treat migraines in the ED. I even discussed the use of Depakote recently. I figured for installment #2 of the WWDWWD series I'd take a step back and discuss the first line IV treatment for refractory migraines in the ED. Before I do that I wanted to make sure that I elaborated on the main goals of ED [...]
