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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 111
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Glasgow Coma Scale in Children

Pediatric EM Morsels

2008 Apr;39(4):1347-8. Epub 2008 Feb 28. [PubMed: 29631516] van Heuven AW, Dorhout Mees SM, Algra A, Rinkel GJ. Validation of a prognostic subarachnoid hemorrhage grading scale derived directly from the Glasgow Coma Scale. doi: 10.1161/STROKEAHA.107.498345. 107.498345. PMID: 18309166.

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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 101
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Heat-Related Illness

Pediatric Emergency Playbook

2008 Nov;36(11):2226-37. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. Heat illness and heat stroke. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. Ishimine P. Hyperthermia. Jardine DS. Pediatr Rev 2007; 28:249.

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Rapid Blood Pressure Lowering in Patients with Acute Intracerebral Hemorrhage

All Ohio EM

While ordinal analysis of the modified Rankin score (assessing changes along the spectrum of the mRS, as opposed to a binary good/poor outcome based on a single cutoff) has become common in stroke trials, there are questions surrounding its use. Delusions of benefit in the International Stroke Trial. 2007;38:2001-2023. 2015;46:000-000.

Stroke 40
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Contrast Media Shortage of 2022 – Lessons Learned

EMDocs

In acute ICM contrast shortages, a tier-based necessity system may preserve contrast for emergent studies such as stroke, hemodynamically unstable trauma, aortic dissection, AAA rupture, active GI bleed, PE, acute mesenteric ischemia, etc. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

Radiology 101
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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].