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

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 13 August 2019

⏱️ 43 minutes

🔗️ Recording | iTunes | RSS

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Summary

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...

Transcript

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0:00.0	This is the EM cases, EM quick hits podcast, where our team of experts and educators bring
0:17.1	you clear, concise, and condensed, practice-changing knowledge on all those EM topics that you may not be totally comfortable with. Cases, the latest evidence, procedural
0:25.0	tips and tricks, pitfalls to avoid, and the key take-home points and references on the
0:29.0	EM cases website. Quick, let's get on with it. First up, we've got Swami on a simple approach
0:35.9	to status epilepticus in adults.
0:38.5	Now, we've covered pediatric status in episode 73.
0:42.1	And spoiler alert, we're going to cover adult status in an upcoming main episode on seizures
0:47.1	this fall.
0:47.9	So here's a little teaser.
0:50.9	I've had a couple of cases of status epilepticus in the last month, and I've seen some people struggle trying to figure out what meds to give, how much of those meds to give, and getting caught up in these complicated algorithms that look good on paper, but aren't really good in the resuscitation phase.
1:06.6	The biggest issue that I see is a lot of consternation around what should my second line agent be.
1:12.2	So I want to give a simplified approach to status epilepticus, and this is mainly for the adult
1:16.8	patient, although I think as a fallback for the pediatric patient, it would be fine as well.
1:22.1	So let's start with a simple definition.
1:24.3	Status epilepticus is anyone who's seizing for more than five minutes.
1:28.0	They have a seizure. They stop. They have a repeat seizure without a return of mental status. Or the way I look at it
1:33.6	is if they come in by EMS and they were seizing and that's why they got picked up and they're still
1:37.5	seizing in front of you, that's status epilepticus. The danger here is that the continued seizure
1:43.0	can lead to acidosis, and that can lead to CV
1:45.7	collapse. And of course, there's the risk for brain damage just from the patient having
1:49.8	multiple seizures in a row. Step one for these patients is going to be to assess the ABCs and get
1:55.8	a blood glucose. Either give glucose if the patient has a low finger stick or just give it empirically. This is one of
	...

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