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For undifferentiated strokes, should blood pressure be aggressively managed pre-hospital?

PulmCCM

Uncontrolled hypertension is a major risk factor for both ischemic and hemorrhagic strokes. Maintaining blood pressure at or near the normal range (again, over long periods) reduces the risk of stroke. Once an acute stroke is underway, however, the calculus changes.

Stroke 52
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52 in 52 – #38: Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke

EMDocs

This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 77
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SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke

The Skeptics' Guide to EM

This has been through various peer reviewed publications, doing Emergency Medicine Abstracts (EMA) audio program […] The post SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. It appears his concerns may have come true. Six trials showed no benefit.

Stroke 52
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Overview of the AHA Essential 8 for Heart Health

AED Leader

The American Heart Association’s Essential 8™ provides an excellent checklist for improving cardiovascular health and reducing the principal risk factors for cardiovascular disease, heart attack, cardiac arrest, and stroke.

Stroke 52
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SGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.

The Skeptics' Guide to EM

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Non-contrast head CT shows a hemorrhagic stroke. [display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. Lancet 2016.

Stroke 52
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Rethinking the Role of TXA: Are We Asking Too Much?

RebelEM

SBP < 75 mm Hg: 39% SBP 76-89 mm Hg: 33% Critical Findings: No statistically significant difference in safety outcomes (DVT, PE, MI, Stroke) TXA Placebo RR (95% CI) Primary Outcome Good Functional Outcome (6 months) 53.7% Lancet 2010; 376(9734): 23-32. Majority of patients (92%) had blunt trauma. 0.94) Mortality 28d 17.3%

Outcomes 101
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The Higher Tech Kid in the ED

Pediatric Emergency Playbook

Also used for severe MS, stroke, TBI, chronic pain. 2010; 30:76–81. 2010; 6: 46-53. Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine. Verify the medication and identify the toxidrome if symptomatic.