Emergency medicine clinics of North America
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A variety of systemic and extra-abdominal diseases can cause symptoms within the abdominal cavity. Systemic and extra-abdominal diseases may include abdominal symptoms caused by several mechanisms. This article discusses the most important and common of these causes, namely the metabolic/endocrine causes, hematologic causes, inflammatory causes, infectious causes, functional causes, and the neurogenic causes.
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Emerg. Med. Clin. North Am. · Feb 2011
ReviewThe diagnosis and management of seizures and status epilepticus in the prehospital setting.
Seizure is one of the most common complaints encountered in the prehospital setting. In this review the authors discuss the prehospital management of seizures and review the evidence for specific treatment approaches. Specific attention is devoted to prehospital care of the pediatric seizure patient. Topics of interest to Emergency Medical Services directors such as patient refusal, resource allocation, and dispatch priority are also addressed.
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Although only 3% of people in the United States are diagnosed with epilepsy, 11% will have at least one seizure during their lifetime. Seizures account for about 1% of all emergency department (ED) visits, and about 2% of visits to children's hospital EDs. Seizure accounts for about 3% of prehospital transports. ⋯ In infants younger than 6 months, hyponatremia and infection are important considerations. Epilepsy is an uncommon cause of seizures in the ED, accounting for a minority of seizure-related visits. Of ED patients with seizure, about 7% have status epilepticus, which has an age-dependent mortality averaging 22%.
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Emerg. Med. Clin. North Am. · Feb 2011
Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols.
Generalized convulsive status epilepticus (GCSE) has a high morbidity and mortality, such that the rapid delivery of anticonvulsant therapy should be initiated within minutes of seizure onset to prevent permanent neuronal damage. GCSE is not a specific disease but is a manifestation of either a primary central nervous system (CNS) insult or a systemic disorder with secondary CNS effects. ⋯ First-line therapies for seizures and status epilepticus include the use of a benzodiazepine, followed by an infusion of a phenytoin with a possible role for intravenous valproate or phenobarbital. If these first-line medications fail to terminate the GCSE, treatment includes the continuous infusion of midazolam, pentobarbital, or propofol.
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Emerg. Med. Clin. North Am. · Feb 2011
The emergency department evaluation of the adult patient who presents with a first-time seizure.
Up to 5% of the population will experience at least 1 nonfebrile seizure at some point during their lifetime. The management of a patient who has had a first-time seizure is driven by the history and physical examination. In almost one-half of these patients, the cause of their seizure is not identified. ⋯ Women of reproductive age also require a pregnancy test. Patients with a normal neurologic examination, normal laboratory results, and no signs of structural brain disease do not require hospitalization or antiepileptic medications. Initiation of antiepileptic therapy depends on the assessed risk for recurrence, in conjunction with a neurologist consultation.