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Abdelsayed N, Juarez A, Carter M. Severe Gastroparesis Leading to Hypoglycemia and Subsequent Seizures. Cureus 2022; 14:e30527. [DOI: 10.7759/cureus.30527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
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Identifying Barriers to Care in the Pediatric Acute Seizure Care Pathway. Int J Integr Care 2022; 22:28. [PMID: 35431702 PMCID: PMC8973859 DOI: 10.5334/ijic.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods: We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children’s Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management. Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management. Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.
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Han EJ, Chuck CC, Martin TJ, Madsen TE, Claassen J, Reznik ME. Statewide Emergency Medical Services Protocols for Status Epilepticus Management. Ann Neurol 2020; 89:604-609. [PMID: 33305853 DOI: 10.1002/ana.25989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
Although seizures are common in prehospital settings, standardized emergency medical services (EMS) treatment algorithms do not exist nationally. We examined nationwide variability in status epilepticus treatment by analyzing 33 publicly available statewide EMS protocols. All adult protocols recommend intravenous benzodiazepines (midazolam, n = 33; lorazepam, n = 23; diazepam, n = 24), 30 recommend intramuscular benzodiazepines (midazolam, n = 30; lorazepam, n = 8; diazepam, n = 3), and 27 recommend intranasal benzodiazepines (midazolam, n = 27; lorazepam, n = 3); pediatric protocols also frequently recommend rectal diazepam (n = 14). Recommended dosages vary widely, and first- and second-line agents are designated in only 18 and 2 states, respectively. Given this degree of variability, standardized national EMS guidelines are needed. ANN NEUROL 2021;89:604-609.
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Affiliation(s)
- Ethan J Han
- Department of Neuroscience, Brown University, Providence, RI
| | - Carlin C Chuck
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI
| | - Thomas J Martin
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Michael E Reznik
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI.,Department of Neurosurgery, Alpert Medical School, Brown University, Providence, RI
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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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Shah MI, Ostermayer DG, Browne LR, Studnek JR, Carey JM, Stanford C, Fumo N, Lerner EB. Multicenter Evaluation of Prehospital Seizure Management in Children. PREHOSP EMERG CARE 2020; 25:475-486. [PMID: 32589502 DOI: 10.1080/10903127.2020.1788194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Seizures are a common reason why emergency medical services (EMS) transports children by ambulance. Timely seizure cessation prevents neurologic morbidity, respiratory compromise, and mortality. Implementing recommendations from an evidence-based pediatric prehospital guideline may enhance timeliness of seizure cessation and optimize medication dosing. OBJECTIVE We compared management of pediatric prehospital seizures across several EMS systems after protocol revision consistent with an evidence-based guideline. METHODS Using a retrospective, cross-sectional approach, we evaluated actively seizing patients (0-17 years old) EMS transported to a hospital before and after modifying local protocols to include evidence-based recommendations for seizure management in three EMS agencies. We electronically queried and manually abstracted both EMS and hospital data at each site to obtain information about patient demographics, medications given, seizure cessation and recurrence, airway interventions, access obtained, and timeliness of care. The primary outcome of the study was the appropriate administration of midazolam based on route and dose. We analyzed these secondary outcomes: frequency of seizure activity upon emergency department (ED) arrival, frequency of respiratory failure, and timeliness of care. RESULTS We analyzed data for 533 actively seizing patients. Paramedics were more likely to administer at least one dose of midazolam after the protocol updates [127/208 (61%) vs. 232/325 (71%), p = 0.01, OR = 1.60 (95% CI: 1.10-2.30)]. Paramedics were also more likely to administer the first midazolam dose via the preferred intranasal (IN) or intramuscular (IM) routes after the protocol change [(63/208 (49%) vs. 179/325 (77%), p < 0.001, OR = 3.24 (2.01-5.21)]. Overall, paramedics administered midazolam approximately 14 min after their arrival, gave an incorrect weight-based dose to 130/359 (36%) patients, and gave a lower than recommended dose to 94/130 (72%) patients. Upon ED arrival, 152/533 (29%) patients had a recurrent or persistent seizure. Respiratory failure during EMS care or subsequently in the ED occurred in 90/533 (17%) patients. CONCLUSIONS Implementation of an evidence-based seizure protocol for EMS increased midazolam administration. Patients frequently received an incorrect weight-based dose. Future research should focus on optimizing administration of the correct dose of midazolam to improve seizure cessation.
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Burroughs ZT, Mitchell MS, Hiestand B, Winslow J. Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study. Acad Emerg Med 2019; 26:1379-1383. [PMID: 31328331 DOI: 10.1111/acem.13834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric seizures are commonly encountered in emergency medical services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement. OBJECTIVE We studied factors associated with EMS protocol compliance for glucose testing in children < 18 years of age with a 9-1-1 call for seizure as well as rates of hypoglycemia in the prehospital setting. METHODS We performed a retrospective analysis of data from the North Carolina EMS registry from 2013 to 2014. North Carolina EMS protocols require glucose measurement prior to seizure treatment. Scene calls for patients ≤ 17 years with a complaint of seizure were included. We calculated incidence of testing, hypoglycemia, and the relative risk of compliance with glucose measurement. RESULTS There were 13,182 calls for seizure, of which 6,262 (47.5%, 95% confidence interval [CI] = 46.6% to 48.3%) had a glucose obtained. Hypoglycemia (glucose < 60 mg/dL) was present in 78 of 6,262 (1.25%, 95% CI = 0.97% to 1.5%) patients. Glucose was supplemented in 61 patients (median glucose 61 mg/dL, interquartile range = 51 to 67 mg/dL). Testing rates increased with age (relative risk [RR] = 1.04 per year, 95% CI = 1.03-1.04 per year), emergency medical technician-paramedic (EMT-P) presence (RR = 1.2, 95% CI = 1.1-1.3) and with antiepileptic medication use (RR = 1.24, 95% CI = 1.1 to 1.2). Testing was less likely in nonwhite patients (RR = 0.95, 95% CI = 0.92 to 0.98). CONCLUSIONS Compliance is suboptimal, varying with patient age, race, and EMT-P presence. Testing increases when antiepileptic drugs are used. Hypoglycemia in tested patients was infrequent; however, proper treatment for hypoglycemic seizures will not be delivered if testing does not occur. It is worthwhile examining the utility of routine testing in this setting; however, until such time as protocols are revised, regional EMS administration should focus on education and uniform compliance with state protocols.
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Affiliation(s)
- Zachary T. Burroughs
- Department of Emergency Medicine Division of Pediatric Emergency Medicine University of South Carolina School of Medicine Greenville SC
| | - Michael S. Mitchell
- Department of Emergency Medicine Division of Pediatric Emergency MedicineWinston‐Salem NC
| | - Brian Hiestand
- Department of Emergency Medicine Wake Forest School of Medicine Winston‐Salem NC
| | - James Winslow
- Department of Emergency Medicine Wake Forest School of Medicine Winston‐Salem NC
- North Carolina Office of Emergency Medical Services Raleigh NC
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Kinnear KM, Warner NM, Haltiner AM, Doherty MJ. Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:65-70. [PMID: 30073145 PMCID: PMC6068315 DOI: 10.1016/j.ebcr.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 01/14/2023]
Abstract
Objectives To investigate if glucose levels influence seizure patterns. Materials and methods In a patient with RNS/NeuroPace implanted bi-temporally and type 1 diabetes mellitus, seizure event times and onset locations were matched to continuous tissue glucose. Results Left focal seizure (LFS, n = 22) glucoses averaged 169 mg/dL, while right focal seizure (RFS, n = 23) glucoses averaged 131 mg/dL (p = 0.03). LFS occurred at mean time 17:02 while RFS occurred at 04:23. LFS spread to the contralateral side (n = 19) more than RFS (n = 2). Conclusion Seizure onset laterality and spread vary with glucose and time of seizure.
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Towards acute pediatric status epilepticus intervention teams: Do we need “Seizure Codes”? Seizure 2018; 58:133-140. [DOI: 10.1016/j.seizure.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
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How do EMS medical directors think? Am J Emerg Med 2017; 35:1376-1378. [DOI: 10.1016/j.ajem.2017.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/21/2022] Open
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Furyk J, Watt K, Emeto TI, Dalziel S, Bodnar D, Riney K, Babl FE. Review article: Paediatric status epilepticus in the pre-hospital setting: An update. Emerg Med Australas 2017. [PMID: 28627014 DOI: 10.1111/1742-6723.12824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.
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Affiliation(s)
- Jeremy Furyk
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kerriane Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Stuart Dalziel
- Starship Children's Hospital, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | - Daniel Bodnar
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Kate Riney
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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Silverman EC, Sporer KA, Lemieux JM, Brown JF, Koenig KL, Gausche-Hill M, Rudnick EM, Salvucci AA, Gilbert GH. Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations. West J Emerg Med 2017; 18:419-436. [PMID: 28435493 PMCID: PMC5391892 DOI: 10.5811/westjem.2016.12.32066] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/14/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California. METHODS We performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately. RESULTS Protocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33) of agencies for adult patients and 76% (25/33) for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33) have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33) of agencies. Forty-two percent (14/33) have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33) allow benzodiazepines to be administered. CONCLUSION Protocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols.
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Affiliation(s)
- Eric C. Silverman
- University of California, San Francisco, School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Karl A. Sporer
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Justin M. Lemieux
- Stanford School of Medicine, Department of Emergency Medicine, Stanford, California
| | - John F. Brown
- University of California, San Francisco, School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Kristi L. Koenig
- University of California, Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Marianne Gausche-Hill
- University of California, Los Angeles, David Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California
| | | | | | - Greg H. Gilbert
- Stanford School of Medicine, Department of Emergency Medicine, Stanford, California
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Hern HG, Kiefer M, Louie D, Barger J, Alter HJ. D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study. PREHOSP EMERG CARE 2016; 21:63-67. [PMID: 27918858 DOI: 10.1080/10903127.2016.1189637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Prehospital first responders historically have used an IV bolus of 50 mL of 50% dextrose solution (D50) for the treatment of hypoglycemia in the field. A local Emergency Medical Services (EMS) system recently approved a hypoglycemia treatment protocol of IV 10% dextrose solution (D10) due to occasional shortages and higher cost of D50. We use the experience of this EMS system to report the feasibility, safety, and efficacy of this approach. METHODS Over the course of 104 weeks, paramedics treated 1,323 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes. Of these, 1,157 (87.5%) patients were treated with 100 mL of D10 initially upon EMS arrival, and full data on response to treatment was available on 871 (75%) of these 1,157. We captured the 871 patients' capillary glucose response to initial infusion of 100 mL of D10 and fit a linear regression line between elapsed time and difference between initial and repeat glucose values. We also explored the need for repeat glucose infusions as well as feasibility, and safety. RESULTS The study cohort included 469 men and 402 women with a median age of 66. The median initial field blood glucose was 37 mg/dL, while the subsequent blood glucose had a median of 91 mg/dL. The median time to second glucose testing was eight minutes after beginning the 100mL D10 infusion. Of 871 patients, 200 (23.0%) required an additional dose of IV D10 solution due to persistent or recurrent hypoglycemia and seven (0.8%) patients required a third dose. There were no reported deaths or other adverse events related to D10 administration for hypoglycemia. Linear regression analysis of elapsed time and difference between initial and repeat glucose values showed near-zero correlation. CONCLUSIONS The results of one local EMS system over a 104-week period demonstrate the feasibility, safety, and efficacy of using 100 mL of D10 as an alternative to D50. D50 may also have theoretical risks including extravasation injury, direct toxic effects of hypertonic dextrose, and potential neurotoxic effects of hyperglycemia. Additionally, our data suggest that there may be little or no short-term decrease in blood glucose results after D10 administration.
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Remick K, Redgate C, Ostermayer D, Kaji AH, Gausche-Hill M. Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management. PREHOSP EMERG CARE 2016; 21:216-221. [DOI: 10.1080/10903127.2016.1218979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rostykus P, Kennel J, Adair K, Fillinger M, Palmberg R, Quinn A, Ripley J, Daya M. Variability in the Treatment of Prehospital Hypoglycemia: A Structured Review of EMS Protocols in the United States. PREHOSP EMERG CARE 2016; 20:524-30. [DOI: 10.3109/10903127.2015.1128031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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