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Friends:

Any suggestions on courses to prepare for the  Peds EM recert exam?

Thanks,

Thom
Thom Mayer, MD, FACEP, FAAP

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Giora (Gill) Winnik
Sent: Tuesday, February 07, 2012 1:34 PM
To: [log in to unmask]
Subject: Status Epilepticus and EEG

 
A 2-year-old child presented to the .ED with a generalized tonic  clonic seizure that started 40 minutes priorto presentation. Pre hospital  the childgot rectal diazepam 10 mg and Ativan 1 mg.
 The child has agenetic disorder and is prone to seizures and is on valproic acid. In theemergency Department the child continues to seize despite 1mg  AtivanX2, Fosphenitoin 20mg/kg, phenobarbital20mg/kg. At that point  lost the gag reflex and therefore was intubated (toprotect the airways)  using Rocuronium asa paralytic. The child was placed on a ventilator, Versed drip and fentanylwere administered.  From that point on noseizures were observed.
 
Questions
 
1)At this point how important would it be for you to monitorthe child's EEG, will you be satisfied with observing a non convulsive state once theRocuronium wears  off and defer the EEG orwill you still insists on an earlier EEG? If your hospital has no immediate EEG monitoringcapabilities would you transfer the child?
2)Does your institution have a 24/7 EEG monitoringcapability?,( I found that few even large centers have that).
3) What are your standards of care for transferring thischild to another center? Do you insist on a team of nurse/paramedic/RT? Or doesyour place allow for a resident,paramedic/or nurse only team . I find that there are nouniform standards .
Thanks for reading this long story and I hope to hear formthe list.


Giora (Gill) Winnik
[log in to unmask]
Maimonides Medical Center
Brooklyn NY




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The URL for the PED-EM-L Web Page is:
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