The Skeptics' Guide to EM

AUGUST 20, 2022

Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile? I knew about Jeff from his multiple publications in the stroke literature. first appeared on The Skeptics Guide to Emergency Medicine. This is an SGEM Xtra.

Stroke 52

Stroke Best Practices EMS Research 52

The Skeptics' Guide to EM

MAY 15, 2021

Daniel Schwerin is employed with Prisma Health-Upstate as a clinical assistant professor, emergency medicine GME director for emergency medical services and medical director for several local EMS agencies and has lectured on prehospital stroke management. Their local EMS service arrives quickly with a conventional ambulance.

Stroke 52

Stroke EMS Outcomes 52

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ). Epub 2018 Oct 6.

Seizures 123

Seizures Stroke Outcomes Research 123

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 91

Stroke Outcomes EMS Seizures 91

RebelEM

FEBRUARY 24, 2025

Of course, there are other methods of assessing fluid tolerance : Capillary refill evaluation, passive leg raise, central venous pressure measurement, pulmonary artery wedge pressures, stroke volume variation, pulse pressure variation, etc. J Invest Surg Sept 2018; PMID: 28952826 Robb J. Intensive Crit Care Nurs. Rudski LG, et al.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

AUGUST 22, 2024

What They Did: Retrospective review of consecutive RAO cases managed as part of a remote ophthalmology consult protocol activated on May 1, 2021, at three stroke centers across a health system. The protocol involved collaboration between the ophthalmology service, ED, and stroke service, including neurology and neuroendovascular teams.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

ACEP Now

JULY 7, 2023

19 Some aspects of the study, including rapid EMS response times and training as well as rapid time to cannulation, limit the generalizability of the data, but overall this study suggests significant promise in the use of ECMO for the management of this patient cohort. References Tsao CW, et al. Circulation. 2022;145(8):e153-e639.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. appeared first on REBEL EM - Emergency Medicine Blog. 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). PMID: 30025734 Sharifi M et al. Am J Cardiol 2013.

Stroke 133

Stroke Outcomes Hospitals Administration 133

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2018. appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 Lancet Haematol 2017. PMID: 28457980 Jehan F et al. The Role of Four-Factor Prothrombin Complex Concentrate in coagulopathy of Trauma: A Propensity Matched Analysis.

Administration 139

Administration Outcomes Resuscitation Radiology 139

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). EMS arrived — and recorded 2 ECGs. 14 minutes later — ECG #2 was recorded by EMS. She has no chest symptoms.

EKG/ECG 118

EKG/ECG EMS Stroke Outcomes 118

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Managing editor of EM:RAP and Associate Editor at REBEL EM. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Managing editor of EM:RAP and Associate Editor at REBEL EM.

Stroke 40

Stroke EMS Administration Wellness 40

RebelEM

MARCH 8, 2023

CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Philadelphia: Elsevier, 2018 (Ch) 61: p. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 97.0 – Acute Vision Loss II appeared first on REBEL EM - Emergency Medicine Blog. Read more

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

RebelEM

FEBRUARY 29, 2024

3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. Post-stroke infection: a systematic review and meta-analysis. Tanaffos 2018 , 17 (2), 110-116. 4, 8 Paper: Dahyot-Fizelier, C., Infect Control Hosp Epidemiol 2014 , 35 (8), 915-936. Westendorp, W.

CDC 111

CDC Radiology Radiology Head Injuries 111

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 FDA granted accelerated approval for andexanet alfa (Andexxa) in May of 2018. You order a non-contrast CT to rule out hemorrhage.

Stroke 52

Stroke Administration EMS Wellness 52

The Skeptics' Guide to EM

MARCH 13, 2021

Fast forward to 2018 and the validation of the Ottawa SAH Rule by Dr. Perry and his group. Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ). This article was covered on the SGEM with EM Nerd Dr. Rory Spiegel.

Stroke 40

Stroke Emergency Department EMS Outcomes 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. She is a graduate from the UC EM residency, class of 2018.

Ultrasounds 64

Ultrasounds CDC Research Stroke 64

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

Dr. Smith's ECG Blog

MARCH 15, 2023

For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. If none of these other factors are present — then the older patient ( ie, beyond 60 years of age, or so ) with new slow AFib should be presumed to have SSS until proven otherwise.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. There is some risk of stroke when converting atrial flutter. In the evening, a middle-aged man complained of chest pain at the nursing home. He was awake, with a pulse of 130 and BP of 50/30. Fluids were started. The patient arrived alert but cool and clammy.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

Dr. Smith's ECG Blog

MARCH 6, 2019

The patients who received emergent PCI had significantly smaller median left ventricular infarct size (8% vs. 13%, p=0.001) measured by single-photon emission computed tomography study, as well as non-significant but underpowered decrease in the composite of death, recurrent MI, or stroke at 30 days (4.4% American Journal of Cardiology 2018.

EKG/ECG 52

EKG/ECG Outcomes Hospitals Wellness 52

EB Medicine

NOVEMBER 1, 2018

In total, they pulled references from 1966 until 2018. Jeff: With your initial stabilization underway, you can begin to gather a more thorough history either from bystanders or EMS if they are still present. CNS dysfunction may be immediate or delayed and can range from strokes to spinal cord injuries.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

SEPTEMBER 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Stroke 2020;51:1326-1332 Connolly ES Jr., Rabinstein AA, Carhuapoma JR, 2018 Mar 5;6:17.

Seizures 98

Seizures Stroke Outcomes EMS 98

The Skeptics' Guide to EM

JULY 4, 2020

hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evidence Based Medicine 2020 Case: A 65-year-old man arrives from home to the emergency department by EMS with right-sided weakness beginning three hours prior. Thrombolysis in acute ischaemic stroke. Reference: Alper et al.

Stroke 52

Stroke Research Hospitals Emergency Department 52

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. 2017.04.011 Witt CE, Bulger EM. Epub 2018 Sep 10.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EB Medicine

DECEMBER 1, 2018

Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. The 2017-2018 vaccine was only 40% effective, but this still translates to 40% less severe cases and a subsequent decrease in hospitalizations and death. Baloxavir is a new single-dose antiviral agent approved by the FDA in October 2018.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

EMDocs

NOVEMBER 2, 2024

We’ll keep it short, while you keep that EM brain sharp. cognitive and behavioral impairment) – 33% Ataxia – 28% Stroke – 23% Ophthalmic symptoms (e.g., The early manifestations of neurosyphilis occur during the secondary stage and include headache , meningitis , stroke , hearing loss , and ocular findings. J Clin Microbiol.

EMS 111

EMS Infectious Diseases CDC Research 111

ACEP Now

DECEMBER 7, 2024

The use of thrombolytics for acute ischemic stroke may be one of the most controversial topics in emergency medicine during the last several decades. 1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. This debate recurs in multiple forums including many previous pieces in ACEP Now.

Stroke 98

Stroke Research Hospitals Outcomes 98

EMDocs

JANUARY 6, 2025

These patients suffer from untreated physical injuries, including gunshot wounds, shrapnel, accidents, envenomations, sequelae of physical or sexual assault, and heat exhaustion/heat stroke. doi:10.1136/bmjgh-2018-001114 Okesanya OJ, Olatunji GD, Kokori E, et al. Published online January 30, 2018. BMJ Glob Health. 2024;30(7).

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72