Episode 933: Benign Convulsions with Gastroenteritis
Release Date: 12/02/2024
Podcast 1005: Balanced Fluid vs Normal Saline in Pediatric Patients
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: There has long been many questions about which IV fluid is best for ED resuscitation Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock The study included about 9,000 patients from 47 emergency departments in five countries Patients with septic shock were randomized to receive either balanced fluid or normal saline The primary outcome was adverse kidney event...
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Carepoint Journal Club: Occlusion Myocardial Infarction
Emergency Medical Minute
Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.
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Podcast 1004: Sinus Arrest Post TAVR
Emergency Medical Minute
Contributor: Taylor Lynch, MD Educational Pearls: Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR) Clinical Features The most common abnormalities include high grade AV block and new onset LBBB Due to the close proximity of the aortic annulus to the AV node and His-Purkinje system More common in males, the elderly, and those with pre-existing conduction disease (RBBB or LBBB) Sinus pauses and sinus arrest are a rare post-TAVR rhythm disturbances Temporary...
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Podcast 1003: Nasal Intubation
Emergency Medical Minute
Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth). Nasal Intubations are seldom preferred to oral intubations as they carry risk for inducing bleeding from trauma to the nasal passages. Indications for nasal intubations include: Anatomical abnormalities that may make...
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Podcast 1002: Elder Agitation
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses,...
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Podcast 1001: Acute Intermediate Risk Pulmonary Embolism
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized...
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Celebrating 1000 Medical Minutes
Emergency Medical Minute
Hosts: Don Stader, Nate Novotny, Travis Barlock, and Jeffrey Olson In this episode, we reminice about the first 1000 medical minutes presented by EMM and what the next 1000 might hold. Below are all of the episodes referenced in this episode. Please go back and give them all a listen. Segment 1- Recap and Facts 1st medical minute o April 29, 2016. Almost exactly 10 years ago. o Diverticulitis and Antibiotics by Dr. Chris Holmes 1000th Medical Minute o March 30, 2026 o Treatment of burns by Aaron Lessen o Edited by Ashley Lyons and published by Jorge Chalit...
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Podcast 1000: Cool Water
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Burns range in complexity from minor first-degree burns to more severe full-thickness burns. Initial basic burn management: Run the burn under cool running water for 20 minutes. Do not scrub the skin. Do not use ice water. Ideally initiated as soon as possible, but no later than 3 hours after injury. Applicable to all burns ranging from superficial to full thickness. Then apply a non-adherent dressing or sterile gauze. Can be done at home or upon presentation to the emergency department. These steps decrease pain and minimize tissue damage....
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Podcast 999: Right vs Left Internal Jugular Access
Emergency Medical Minute
Contributor: Travis Barlock, MD Educational Pearls: What is an internal jugular catheter (IJ) and when do we use it? IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins). IJs are used when the patient may require long-term venous access or have to receive hyperosmolar solutions (such as solutions with high glucose content for parenteral nutrition); solutions with extreme pHs (<5 or >9);...
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Podcast 998: Delayed Intubation After an Overdose
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field? A 2025 study in the Annals of Emergency Medicine took a look at this question Methods Prospective, multi-institutional cohort study Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances. This paper performed a secondary analysis evaluating the risk of “delayed intubation,” defined as intubation occurring >4 hours after ED arrival. Results 1,591 patients with presumed opioid...
info_outlineContributor: Alec Coston MD
Educational Pearls:
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Causes of seizures in a fairly well-appearing child with diarrhea:
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Electrolyte abnormalities: hypocalcemia, hyponatremia
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Also hyperkalemia which causes arrhythmias and syncope - can appear like seizures
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Hypoglycemia
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If the child has diarrhea and appears very sick, differential diagnosis may include:
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Hemolytic uremic syndrome (HUS):
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simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury
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Typically caused by Shiga-like toxin producing Escherichia coli (also known as EHEC, or enterohemorragic E. coli)
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One of the main causes of acute kidney injury in children
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Toxic ingestions such as salicylates, lead, or iron
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In this case, the child had a seizure but appeared well and was afebrile:
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Consult with neurology led to a diagnosis of benign convulsions with mild gastroenteritis (CwG)
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First identified in 1982 in Japan
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Viral gastroenteritis with diarrhea and convulsions but does not include fever, severe dehydration, or electrolyte abnormalities
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Uncommon illness caused by rotavirus and norovirus pathogens
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Criteria for discharge is similar to a febrile seizure - the patient had one seizure that lasted less than 15 minutes and he quickly returned to his baseline, so he was able to be safely discharged home
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This diagnosis does not predispose him to epilepsy later in life
References
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Lee YS, Lee GH, Kwon YS. Update on benign convulsions with mild gastroenteritis. Clin Exp Pediatr. 2022 Oct;65(10):469-475. doi: 10.3345/cep.2021.00997. Epub 2021 Dec 27. PMID: 34961297; PMCID: PMC9561189.
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Mauritz M, Hirsch LJ, Camfield P, et al. Acute symptomatic seizures: an educational, evidence-based review. Epileptic Disorders. 2200;1(1). doi:https://doi.org/10.1684/epd.2021.1376
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Noris, Marina*; Remuzzi, Giuseppe*, †. Hemolytic Uremic Syndrome. Journal of the American Society of Nephrology 16(4):p 1035-1050, April 2005. | DOI: 10.1681/ASN.2004100861
Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3
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