EMDocs

JANUARY 29, 2024

This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes. Ischemic Strokes: Ischemic stroke is characterized by a blockage of a blood vessel in the brain. The BP targets for patients with ischemic strokes depend on the available therapeutic options.

Stroke 73

Stroke Outcomes EMS Seizures 73

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

JANUARY 29, 2024

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 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).

Stroke 137

Stroke Outcomes Hospitals Administration 137

PulmCCM

JULY 10, 2023

A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C., 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 126

CDC Outcomes Radiology Radiology 126

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Philadelphia: Elsevier, 2018 (Ch) 61: p. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. In 2018, three modern trials comparing asa vs placebo for primary prevention were published. This difference easily met statistical significance. All were nonsignificant.

Stroke 91

Stroke Academics Outcomes Shock 91

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Downeast Emergency Medicine

OCTOBER 1, 2021

TNK is easier to prepare and administer (a rapid, single-bolus) which may mean faster door-to-needle times and faster door-in-door-out times for transport (and hopefully translate into less disability after stroke). AHA/ASA Guidelines: 2018: “Tenecteplase administered as a 0.4-mg/kg Holmes, MD References NOR-TEST Lancet Neurology.

Stroke 52

Stroke Administration Outcomes 52

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

The Skeptics' Guide to EM

NOVEMBER 7, 2018

[display_podcast] Date: November 6th , 2018 Reference: Sprigg et al. 2018 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. display_podcast] Date: November 6th , 2018 Reference: Sprigg et al. This is Bob’s eighth visit to the SGEM. This is Bob’s eighth visit to the SGEM.

Stroke 40

Stroke Outcomes 40

Pediatric Education

SEPTEMBER 3, 2023

High-quality studies in the SCT population are needed to clarify the health-outcomes as many studies are necessarily smaller or not able to be performed as rigorously. There is no positive association for deep venous thrombosis, cardiomyopathy, heart failure, stroke and no abnormalities of growth parameters in the pediatric population.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

ACEP Now

MAY 9, 2024

1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.” These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Sensible Medicine

FEBRUARY 28, 2024

JMM Although the skeptical cardiologist questions the value of many procedures and diagnostic tests in cardiology, he remains an enthusiastic advocate of the use of coronary artery calcium (CAC) testing to better personalize each individual's risk of heart attack and stroke.

Stroke 44

Stroke Documentation/Coding Outcomes Wellness 44

The Skeptics' Guide to EM

MARCH 13, 2021

You page neurosurgery at the bigger ED in town, and while you wait for the page back, you wonder if giving tranexamic acid (TXA) could help improve the patient’s chances for a good outcome given its effects in other bleeding processes. Fast forward to 2018 and the validation of the Ottawa SAH Rule by Dr. Perry and his group.

Stroke 40

Stroke Emergency Department EMS Outcomes 40

EMDocs

JULY 20, 2023

A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. The blinded assessment of the primary outcome was done through both in-person interviews and over the telephone. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.

Stroke 72

Stroke Outcomes Head Injuries Psychiatric 72

Dr. Smith's ECG Blog

MAY 30, 2023

IV fluids for more preload are indicated, but not too much, as the RV can be overloaded with fluid, cause the septum to bow into the LV, and then harm LV stroke volume and cardiac output, leading to worsening hypotension, worse RV perfusion, worse RV function, and more RV failure. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ).

Shock 82

Shock EKG/ECG Academics Stroke 82

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. Outcome: All 4 serial hs troponin I, out to 6 hours, were undetectable. 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 ). She has no chest symptoms. What is the diagnosis?

EKG/ECG 107

EKG/ECG EMS Stroke Outcomes 107

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

PulmCCM

NOVEMBER 20, 2024

Large observational series and meta-analyses followed, suggesting strong tendencies toward improved outcomes in patients without ARDS treated with low tidal volumes. After 28 days, patients in the protective ventilation group had worse outcomes (all statistically significant): 28.9% 4 to 6 ml/kg) for patients with ARDS. versus 45.3%.

Stroke 88

Stroke Outcomes 88

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 6, 2019

I believe this is by far the most common outcome for this patient around the world in 2019. Just because none of them had a disastrous outcome in a small, highly monitored study population does not mean they won't have bad outcomes in normal practice. No other clinical outcomes were reported. vs. 6.6%, p=0.37).

EKG/ECG 52

EKG/ECG Outcomes Hospitals Wellness 52

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). What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

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. Introduction SAH has the potential for rapid progression and devastating outcomes. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 85

Seizures Stroke Outcomes EMS 85

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. Bandarkar, A.N. and Blask, A.R., Barbosa, J.A., Coelho, A.Q.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

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. Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Sensible Medicine

JANUARY 9, 2024

Glyn Elwyn and I wrote in a 2018 paper “in the vast majority of circumstances, the only outcome of relevance for EBP (evidence-based practice) is to measure whether a shared decision was made.” First, I believe in most cases it is not our job to “convince” someone to take a medication like a statin.

Stroke 92

Stroke Outcomes Wellness Evidence-Based Practice 92

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% 8 The data in Mayer et al.

Stroke 86

Stroke Radiology Radiology Emergency Department 86

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: To attain the most up to date information for this article, Dr. Williams searched the PubMed and Cochrane Databases from 1950 to 2018. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 4, 2024

80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. Cause and outcome of atypical chest pain in patients admitted to hospital. 2018 Nov;19(6):952-960.

Emergency Department 98

Emergency Department Fractures Burns EMS 98