EMDocs

AUGUST 13, 2024

From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. Background Hypertension (HTN) is significant issue globally and a leading risk factor for cardiovascular disease. HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years.

Stroke 85

Stroke Administration Outcomes Hospitals 85

Taming the SRU

SEPTEMBER 12, 2024

Neuromuscular (NM) weakness can have various causes, ranging from common and relatively easy to diagnose conditions (such as strokes and trauma) to less common and more difficult to diagnose ones (such as vascular pathologies, infections, autoimmune diseases, and neoplasms). Stroke: causes and clinical features. 80 , 711–721 (2013).

Stroke 88

Stroke 88

PulmCCM

JULY 10, 2023

Read in JAMA When to start anticoagulation after ischemic stroke from atrial fibrillation It’s been unclear when to start anticoagulation after an ischemic stroke presumed due to thromboembolism from atrial fibrillation. Aspirin is sometimes given during the waiting period. Heparin infusions are usually avoided.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. PMID: 23102885 Aykan AC et al. Clin Exp Emerg Med 2023.

Stroke 137

Stroke Outcomes Hospitals Administration 137

RebelEM

MARCH 8, 2023

CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Philadelphia: Elsevier, 2013 (Ch) 26: p. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

RebelEM

SEPTEMBER 28, 2023

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. PMID: 37439219 Armstrong P et al. Fibrinolysis or Primary PCI in ST-Segment elevation Myocardial Infarction.

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

Pediatric Emergency Playbook

AUGUST 1, 2020

2013 Jul-Aug; 48(4): 546–553. Heat illness and heat stroke. J Athl Train. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P. Hyperthermia. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. Jardine DS.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Best Practices Pediatrics 52

The Skeptics' Guide to EM

JUNE 11, 2017

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

Stroke EMS Outcomes 52

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). CT reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Symptoms began just prior to presentation.

EMS 50

EMS Stroke Emergency Department 50

All Ohio EM

SEPTEMBER 16, 2019

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. June 30, 2013 by Rory Spiegel. Delusions of benefit in the International Stroke Trial.

Stroke 40

Stroke Outcomes Research Hospitals 40

Taming the SRU

FEBRUARY 12, 2024

DISCUSSION Epidemiology and Background Rivaroxaban, along with other direct oral anticoagulants (DOACs), has become a mainstay of treatment for pro-thrombotic conditions since 2011. [1] 3-5] From a patient perspective, DOACs are favorable for daily dosing, oral intake, and lack of frequent clinical visits for dosing adjustments. Apr; 30(3): 85–95.

Administration 79

Administration Fractures Anaphylaxis Head Injuries 79

Pediatric Emergency Playbook

OCTOBER 1, 2017

Also used for severe MS, stroke, TBI, chronic pain. 2013; 49:138–144. 2013; 29:347–349. 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.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. The Lancet 2020 This was an SGEM Journal Club episode recorded live at McGill University Grand Rounds. This was the third time coming to McGill University Department of Emergency Medicine to give Grand Rounds.

Academics 52

Academics Resuscitation EMS Research 52

Don't Forget the Bubbles

JUNE 30, 2023

CRASH 2 , published in 2013 – was huge. Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. 2013 Mar;17(10):1-79. But, there’s always been a worry that giving TXA could cause clotting in the cerebral vessels. This is not good. There have been a couple of landmark trials.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

The Skeptics' Guide to EM

MARCH 13, 2021

Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ). Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ). Jeff Perry and his group in the development of the Ottawa SAH Rule.

Stroke 40

Stroke Emergency Department EMS Outcomes 40

PulmCCM

JANUARY 22, 2024

Most large subsequent trials showed no beneficial effects of TTM: In 2013, a trial more than three times larger than the original trials (NEJM, n=950) showed no benefit of cooling to 33°C compared to maintenance at 36°C, in either survival or neurologic outcome.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Taming the SRU

FEBRUARY 5, 2024

Clin Infect Dis. 2018;66(3):321-328. doi:10.1093/cid/cix806 5. Glimåker, M., Johansson, B., Ericsson, M., Bläckberg, J., Lindquist, L., & Sjölin, J. Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines. Scandinavian journal of infectious diseases , 45 (9), 657–663. Heyderman, R.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

ACEP Now

JULY 7, 2024

2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. 2013; 54 Suppl 7:23-34 Chin RFM et al., Nonconvulsive seizures are common in critically ill children. Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Taming the SRU

OCTOBER 7, 2024

The contraindications are the same as for the non-pregnant patient including: prior ICH, known brain lesion/malignancy, ischemic stroke in the past three months, suspected aortic dissection, active bleeding, and closed head trauma in the past three months. 2013 Apr;98(4):545-8. Haematologica. doi: 10.3324/haematol.2012.072009.

Ultrasounds 63

Ultrasounds CDC Research Stroke 63

RebelEM

MARCH 22, 2023

Resources REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush References Brugada P et al.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

Mind The Bleep

FEBRUARY 12, 2024

Examples of causes of each are listed below. Anisocoria – EyeWiki. online] EyeWiki. Available at: [link] Salmon, J. Kanski’s Clinical Ophthalmology / a Systematic Approach. Amsterdam: Elsevier. Simpson, A. Examination of the Eyes and Vision – OSCE Guide. online] Geeky Medics. Available at: [link] Sweeney, A.R., Prakalapakorn, S.G., and Lee, S.

Stroke 52

Stroke Pediatrics 52

PulmCCM

JANUARY 24, 2024

Most large subsequent trials showed no beneficial effects of TTM: In 2013, a trial more than three times larger than the original trials (NEJM, n=950) showed no benefit of cooling to 33°C compared to maintenance at 36°C, in either survival or neurologic outcome.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Sensible Medicine

MARCH 11, 2024

A couple of real-life examples A) The main outcome from the 2000 HOPE trial (ramipril versus placebo in higher cardiovascular risk patients) was the risk of heart attacks/strokes (CVD) over 5 years. if the risk of heart attacks/strokes in each group was the same, say, 10%, then the risk ratio, 10%/10% = 1. in favour of ramipril.

Outcomes 102

Outcomes Research Stroke COPD 102

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Pediatric Emergency Playbook

MAY 1, 2016

For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke). 2013; 28:145–284. Keep your mind open to the possibilities, and be ready to change it, when new information becomes available. Try this for altered children: remember that they need their VITAMINS! V – Vascular (e.g.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

ACEP Now

APRIL 2, 2024

Carolina Reaper, under whose effects I was suffering, is a cultivar of ( Capsicum chinense ) and was declared in 2013 to be the hottest chili pepper in the world with greater than 1.6 1 Adding more confusion, some countries refer to these fruits as ‘peppers’ when they are fresh and ‘chilies’ when they are dried. A habanero pepper.

Burns 40

Burns Poisoning Seizures Stroke 40

ACEP Now

MARCH 14, 2024

2013:1960-62. Tracheo-innominate artery fistula after stroke. The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. 169:334-48. Quereshi AZ. Fatal innominate artery hemorrhage in a patient with tetraplegia: case report and literature review. Ann Thorac Cardiovasc Surg. 10, 2023;21-5.

Operations 52

Operations Pediatrics Radiology Radiology 52

PulmCCM

SEPTEMBER 13, 2021

This is analogous to a left ventricle with constant stroke volume and heart rate, respectively. Tedford RJ: Determinants of right ventricular afterload (2013 Grover Conference series). However, the following model should dispel some of these half-truths. Investigative Ophthalmology & Visual Science 1965, 4(6):973-987.

Burns 40

Burns Stroke Ultrasounds Wellness 40

EMDocs

OCTOBER 30, 2023

3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. Reducing CECT performance, ICM dose reduction, and deferment of diagnostic imaging are strategies to combat contrast shortage.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

PulmCCM

NOVEMBER 20, 2024

Patients with acute brain injuries due to strokes or trauma were generally excluded from trials testing low tidal volume ventilation, because of potential harms from elevated blood carbon dioxide levels or impairment of cerebral blood flow by high positive end-expiratory pressure (PEEP). 2013 Feb 28;2013(2):CD003844. 202409-1766ED.

Stroke 93

Stroke Outcomes 93

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. Cardiology in the Young; 2013. 2013; 88(10): 1127–1140. 2013; 29:715-719. 2013; 14(8): e380–e387. Don't go looking, if you won't do anything with the test. J Am Coll Cardiol. 2012; 60(23): 2427-2463. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

JANUARY 1, 2017

The FPS-R uses more neutral and realistic faces and, unlike the Wong Baker scale, does not use smiling or crying faces to anchor the extremes of pain ( Tsze 2013 ). Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly. PAIN PHYSIOLOGY Pain includes two major components: generation and perception.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Pediatric Emergency Playbook

JUNE 1, 2016

Conversely, is the heart rate too slow – even if the stroke volume is sufficient, if there is severe bradycardia, then cardiac output -- which is in liters/min – is decreased. 2013 Oct;132(4):663-7. 2013; 41:580-637. 2013; 17:R246. If so, use 1 J/kg to synchronize cardiovert. Chemically pace with atropine, 0.01

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Pediatric Emergency Playbook

JUNE 1, 2017

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. 2013; 34(3):489-491. 2013; 34(4). 2013; 8(2):61-63. 2013; 6(5):752-761. 2013; 57:812-819. 2014; 5(4)L631-634.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. Additional Points about MINOCA: I found it surprising to learn that the initial description of acute MI despite normal coronary vessels is not a new concept — having been first described ~80 years ago ( with eventual adoption of the term, "MINOCA" in 2013 ). Left ventricular end-diastolic volume: 99 ml.

EKG/ECG 101

EKG/ECG Ultrasounds Wellness Stroke 101