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EM@3AM: Brainstem Strokes

EMDocs

Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

Stroke 110
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Glasgow Coma Scale in Children

Pediatric EM Morsels

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?

EMDocs

This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes. Ischemic Strokes: Ischemic stroke is characterized by a blockage of a blood vessel in the brain. The BP targets for patients with ischemic strokes depend on the available therapeutic options.

Stroke 99
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Rapid Blood Pressure Lowering in Patients with Acute Intracerebral Hemorrhage

All Ohio EM

By Mike Pallaci, DO Research Question: Does rapid lowering of blood pressure improve the outcome in patients with intracerebral hemorrhage? The primary outcome was determined for 2794 of these; 45 patients (1.6%) lost to follow-up. How Many Patients: The investigators enrolled 2839 patients.

Stroke 40
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Contrast Media Shortage of 2022 – Lessons Learned

EMDocs

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. West J Emerg Med. 2017;18(5):835-845.

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Diagnostics: Inflammatory Markers

Taming the SRU

A 2008 review in the International Journal of Medicine on spinal epidural abscess (SEA) agreed that inflammatory markers (specifically ESR and CRP) are generally sensitive in the diagnosis of SEA, but are not specific. 2008 Aug;75(8):557-66. Notably, up to 40% of patients with native vertebral osteomyelitis had a normal WBC [33-34].

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What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

I believe this is by far the most common outcome for this patient around the world in 2019. Just because none of them had a disastrous outcome in a small, highly monitored study population does not mean they won't have bad outcomes in normal practice. No other clinical outcomes were reported. American Heart Journal 2008.

EKG/ECG 52