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Grand Rounds Recap 5.22.24

Taming the SRU

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. Benefits of transport are evidenced based.

Shock 90
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SGEM#310: I Heard A Rumour – ER Docs are Not Great at the HINTS Exam

The Skeptics' Guide to EM

You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke. You wonder, “Why can’t I just rule out stroke with the HINTS exam? Posterior circulation strokes account for approximately up to 25% of all ischemic strokes [1].

Stroke 40
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MI in Children

Pediatric Emergency Playbook

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI. 2009; 8:67-69.

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Big Labs, Little People

Pediatric Emergency Playbook

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. 2009; (55) 12:2098–2112. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Don't go looking, if you won't do anything with the test. Pediatr Emer Care. 2014;30: 493-495.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients Arch Intern Med 2009 Jul 27; 169:1299-1305. Arch Intern Med 2009 Jul 27; 169:1262. Ann Emerg Med 2009 Dec; 54:769.

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Is One of the Most Popular Cardiac Drugs Better than its Generic Competitor?

Sensible Medicine

The primary endpoint of CV death, MI or stroke occurred in 9.8% KM curves for the primary endpoint of death, MI and stroke The PLATO Controversy Foy, Ruzieh and I have revised our PLATO coverage over at CardiologyTrials. 4 Lack of Replication of Ticagrelor superiority over Clopidogrel PLATO was published in 2009. The HR was 0.84

Stroke 101