The Skeptics' Guide to EM

OCTOBER 3, 2020

Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. NEJM […] The post SGEM#303: Two Can Make It – Less likely to have another stroke but more likely to have a bleed (THALES Trial) first appeared on The Skeptics Guide to Emergency Medicine. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.

Stroke 40

Stroke Emergency Department Research Wellness 40

Don't Forget the Bubbles

NOVEMBER 27, 2023

The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Published 2021 Apr 16. link] Roland D. Don’t Forget The Bubbles.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

ACEP Now

JULY 7, 2023

Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. References Tsao CW, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

The Skeptics' Guide to EM

JUNE 11, 2017

[display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. 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. display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al.

Stroke 52

Stroke EMS Outcomes 52

Pediatric EM Morsels

JULY 21, 2023

Validation of a prognostic subarachnoid hemorrhage grading scale derived directly from the Glasgow Coma Scale. 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345. 107.498345. Epub 2008 Feb 28. PMID: 18309166. Lammers DT, Marenco CW, Do WS, Conner JR, Horton JD, Martin MJ, Escobar MA Jr, Bingham JR, Eckert MJ.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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). Cases 5 , 270–279 (2017). & Werring, D. Abingdon Engl.

Stroke 89

Stroke 89

PulmCCM

NOVEMBER 11, 2021

To focus matters, the hemodynamic variable under consideration is the stroke volume [SV]; in other words, how does a push of phenylephrine affect SV? ’ Diminished stroke volume? In the former group, stroke index [i.e., SV] increased significantly, while in the latter group, stroke index fell in response to phenylephrine.

Stroke 40

Stroke Sepsis Administration Wellness 40

RebelEM

JUNE 26, 2023

Lancet Haematol 2017. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 PMID: 28457980 Jehan F et al.

Administration 145

Administration Outcomes Resuscitation Radiology 145

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Vital signs were within normal limits on arrival to the Emergency Department.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

PulmCCM

DECEMBER 12, 2024

However, embolized patients had nominally higher rates of death at 90 days (5% vs ~3%), functional deterioration (~12% vs ~10%), and disabling stroke (2 patients), leading authors to suggest caution while awaiting further safety data on the procedure. that were not associated with any research study) between 2017 and 2023, according to CMS.

Stroke 52

Stroke Operations Research 52

The Skeptics' Guide to EM

AUGUST 19, 2023

In 2017, the SGEM reviewed the ATACH-2 trial ( SGEM#172 ) which showed similar results. CT reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. A meme was also posted of Charlton Heston from the classic movie the Ten Commandments. It emphasized that GUIDElines are not GODlines.

EMS 74

EMS Stroke Emergency Department 74

Don't Forget the Bubbles

FEBRUARY 5, 2025

It can cause significant internal injuries, including carotid artery dissection, stroke, and acquired brain injury, but in 50% of patients, there are no external signs of injury. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms. General Medical Council.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

PulmCCM

APRIL 8, 2024

In a 2017 observational study at 43 French ICUs , gradual weaning was associated with less airway obstruction and gasping; families reported no greater incidence of PTSD symptoms after witnessing either type of extubation, while nurses reported more work stress with gradual weaning. If no significant structural heart disease (e.g.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76

Seizures 113

Seizures EKG/ECG EMS Stroke 113

The Skeptics' Guide to EM

APRIL 6, 2019

He reports he has been taking apixaban to prevent stroke in the context of atrial fibrillation, which you easily recognize as one of the modern oral anti-Factor Xa inhibitors. The full study cohort of 503 patients has since been published ( Pollack et al NEJM 2017 ) and we are in the same place we were in 2015.

Stroke 52

Stroke Administration EMS Wellness 52

Sensible Medicine

JULY 6, 2023

In short, the 41-month, placebo-controlled trial of nearly 14,000 statin-intolerant patients trial found: LDL decreased by 21% more in the bempedoic arm at 6 months 4-point MACE (CV death, MI, stroke, or coronary revascularization) was reduced by 1.6% (13.3% placebo vs 11.7% vs 8.6%) and elevated liver enzymes (4.5%

Outcomes 84

Outcomes Stroke Wellness 84

Pediatric Education

JULY 23, 2023

In adults, cryptogenic stroke is a current indication for treatment of an identified PFO. Adults with a cryotogenic stroke are more likely to have a PFO (up to 40-50%), and a 2017 New England Journal of Medicine study found that interventional closure of adult PFO decreased recurrent ischemic strokes. N Engl J Med.

Stroke 40

Stroke Pediatrics Outcomes Hospitals 40

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. However, there is not good evidence that therapeutic hypothermia is neuroprotective in ischemic or hemorrhagic stroke, IHCA or traumatic brain injury. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

PulmCCM

JANUARY 22, 2024

The trial was later dubbed “TTM1” A 2017 trial (JAMA, n=355) did not find benefit in neurologic outcome with prolonged cooling to 33°C for 48 hours, but may have been underpowered (the intervention group had a nonsignificant absolute 5% improvement).

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

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. J Thromb Haemost.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

Taming the SRU

AUGUST 30, 2023

In contrast, an 2017 Cochrane Review update regarding using PCT to initiate or discontinue antibiotics found PCT-guided therapy had a statistically significant d ecrease in mortality for hospitalized patients by 1.4% (primary endpoint) and a statistically significant decrease in antibiotic exposure by 2.4 2017 Dec 14;9(6):7204-7218.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Critical Care Now

MAY 12, 2022

The Pre-brief When we think of lysing things in the emergency department (ED), we think of alteplase busting up a blood clot in either ischemic stroke or in patients experiencing a massive pulmonary embolism. 2017; 156(1_suppl): S1 – S29. Interests include trauma, toxicology, and infectious diseases. 2007; 75: 1523 – 28. Ann Emerg Med.

Infectious Diseases 52

Infectious Diseases Stroke Emergency Department Administration 52

Downeast Emergency Medicine

APRIL 26, 2021

MI or stroke). Secondary outcomes were early head injury related death (within 24 hours after injury), all-cause and cause-specific mortality, disability, vascular occlusive events (MI, stroke, DVT, PE), seizures, complications, neurosurgery, days of ICU care, and adverse events within 28 days. in the TXA group and 9.9%

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

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

Mind The Bleep

FEBRUARY 12, 2024

doi:[link] Dr Mary Lowth (2017). Examples of causes of each are listed below. Bilateral congenital mydriasis in a child case. Turk Pediatri Arsivi-turkish Archives of Pediatrics , [online] 51(3), pp.176–177. Pupillary Abnormalities. online] Patient.info. Available at: [link] GP Notebook (2018). Miosis (bilateral). online] GP Notebook.

Stroke 52

Stroke Pediatrics 52

PulmCCM

JANUARY 24, 2024

The trial was later dubbed “TTM1” A 2017 trial (JAMA, n=355) did not find benefit in neurologic outcome with prolonged cooling to 33°C for 48 hours, but may have been underpowered (the intervention group had a nonsignificant absolute 5% improvement).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

ACEP Now

APRIL 2, 2024

8,9 There is one case of a 17-year-old who died from acute cerebellar stroke after participating in the “One Chip Challenge” (eating a capsaicin infused food chip as a game) that prompted Hershey Co. 2018:bcr-2017- 224085. Capsaicin pepper exposures send about 300-350 people to the hospital annually. to recall the product.

Burns 40

Burns Poisoning Seizures Stroke 40

Taming the SRU

MAY 3, 2023

Furthermore, these rapid changes in pulmonary vascular resistance can lead to significant reduction in RV stroke volume and subsequent RV dilation & tricuspid regurgitation (16). 2017 conducted a systematic review of two randomized control trials (7,20,21).

Wellness 52

Wellness Hospitals Shock Outcomes 52

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. 2017; 15:47-50. However, the presence of PFO alone does not connote higher risk. Interactive Cardiovascaulr and Thoracic Surgery.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

SEPTEMBER 1, 2018

Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Jeff: And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

MAY 3, 2019

Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. Additional screening tests should be considered in those with new psychiatric symptoms who are 65 years or older, those who are immunosuppressed, and those with concomitant medical disease.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C Bendall, J.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. 14 The American Stroke Association (ASA) and American Heart Association (AHA) recommend SBP <160 mmHg until definitive management of the bleed is completed.

Seizures 98

Seizures Stroke Outcomes EMS 98

Don't Forget the Bubbles

AUGUST 21, 2023

Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). See their website for more: [link] References Annual Report on Cardiothoracic Organ Transplantation 2017/2018, NHS Blood and Transplant Ashkanase A., 24; 15-25 Fenton M.,

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Don't Forget the Bubbles

FEBRUARY 7, 2024

“Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. The cremasteric reflex The cremasteric reflex is a superficial reflex in males, triggered by lightly stroking the inner part of the thigh. The cremaster muscle contracts, elevating the testicle on that side. Schwarz, G.M. and Cakmak, M.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

The Skeptics' Guide to EM

APRIL 3, 2021

mg/kg) was beneficial for unknown onset stroke above a certain core size. Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. Background: We have talked about stroke management a number of times recently including SGEM#297 on the reanalysis of ECASS-3 by Alper et al 2020.

Stroke 52

Stroke Research Outcomes Emergency Department 52

Dr. Smith's ECG Blog

APRIL 8, 2015

to 1.45) for fatal or nonfatal stroke. Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). g/dL —Hypotension (obviously!) Thiruganasambandamoorthy, V., Baumann, B.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52