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Seizure Clinical Policies: How can we use them to improve ED seizure patient care?

Seizure Clinical Policies: How can we use them to improve ED seizure patient care?. FERNE/EMRA Session Chicago, IL May 18, 2007. Andrew Zinkel, MD EMRA President-Elect Emergency Medicine Resident Department of Emergency Medicine University of Illinois at Chicago Chicago, IL.

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Seizure Clinical Policies: How can we use them to improve ED seizure patient care?

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  1. Seizure Clinical Policies:How can we use them to improve ED seizure patient care?

  2. FERNE/EMRASessionChicago, ILMay 18, 2007

  3. Andrew Zinkel, MDEMRA President-ElectEmergency Medicine ResidentDepartment of Emergency MedicineUniversity of Illinois at ChicagoChicago, IL

  4. Seizure Case Presentation • A 32 year old patient has a brief new onset generalized seizure and is alert with a normal neurological exam in the ED. He has no medical history or co-morbidities. • What work-up is indicated in the ED? • What neuroimaging? When? • What overall evaluation in necessary? • Is admission indicated? AED initiation? Andrew Zinkel, MD

  5. Seizure Case Presentation • A 45 year old patient has a generalized seizure and is medically stable to be discharged. He has been noncompliant with his oral Dilantin, and need to be loaded with this anti-epileptic drug • What is the best way to deliver a phenytoin load in the ED? • Oral or IV phenytoin? • IV or IM fosphenytoin? • Why? Andrew Zinkel, MD

  6. Seizure Case Presentation • A 65 year old patient has a generalized seizure that does not stop despite diazepam administration by the CFD and adequate ED doses of lorazepam and fosphenytoin. • What bolus injection or continuous infusion AEDs must be administered in what order? Why? • When is EEG monitoring indicated? Andrew Zinkel, MD

  7. Seizure Case Presentation • A 10 year old patient has a generalized seizure while at school. She presents to the ED with mild confusion, but an otherwise normal exam. • What seizure clinical polices apply to the management of pediatric seizure patients? • Can those developed for adults be utilized when treating pediatric patients? Andrew Zinkel, MD

  8. Seizure Case Presentation • A recently graduated Emergency medicine resident starts his first job in a new Emergency Department. He wonders to himself… • Does my hospital have a protocol for the management of seizure and SE patients? • Are there guidelines that govern the ED management of these patients? • Do guidelines help or hurt me? Andrew Zinkel, MD

  9. Questions? www.FERNE.org azinkel1@uic.edu ferne_emra_2007_sz_zinkel_cases_051707 9/28/2014 11:37 AM Andrew Zinkel, MD

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