RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. 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. Exclusion Criteria: Patients under 18 years of age.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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 91

Stroke Outcomes EMS Seizures 91

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. 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. Why does it matter?

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

JULY 5, 2024

But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. That would likely slow the ventricular rate as well, but would have a higher likilihood of converting to sinus. We want to avoid a stroke. What AV nodal blocker should we give? How about amiodarone?

EKG/ECG 114

EKG/ECG Stroke Administration Ultrasounds 114

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

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2018. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention.

Administration 139

Administration Outcomes Resuscitation Radiology 139

Sensible Medicine

SEPTEMBER 23, 2024

In 2018, three modern trials comparing asa vs placebo for primary prevention were published. The rate of the composite primary outcome of CV death, MI, unstable angina, stroke or transient attack was 4.29% with asa vs 4.48% with placebo. Well more than a million views per month far exceeds are expectations.

Stroke 110

Stroke Academics Outcomes Shock 110

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

Don't Forget the Bubbles

JUNE 30, 2023

Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. Well, one study in Kornelson’s systematic review and meta-analysis is interesting. published in 2018, looked at 1900 matched pairs of injured children under 12, half of whom received TXA. 2018 Dec;19(12):e637-e642. doi: 10.1097/PCC.0000000000001724.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

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. Patient data anonymized when presented to adjudication committee to avoid detection bias Well-balanced patient characteristics between groups. Post-stroke infection: a systematic review and meta-analysis.

CDC 111

CDC Radiology Radiology Head Injuries 111

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. hours of right sided weakness as well as slurred speech. hours of right sided weakness as well as slurred speech. Date: May 19th, 2020 Reference: Yang P et al.

Stroke 40

Stroke EMS Administration Wellness 40

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And so was an appropriate anti-coagulant, since atrial flutter, like fibrillation, can result in thromboembolism and stroke. She did well. That said — today's case highlights how use of antiarrhythmic medication may account for AFlutter presenting with an atrial rate well under the "expected" 300/minute.

EKG/ECG 128

EKG/ECG Stroke Administration Wellness 128

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

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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. The RV is supplied during systole as well as diastole.

Shock 97

Shock EKG/ECG Academics Stroke 97

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2018 USA multi-center prospective RCT involving 1,656 adult patients published in NEJM used varying PCT cut-offs to guide antibiotic initiation in the emergency department. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19.

Infectious Diseases 89

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

Pediatric Education

SEPTEMBER 3, 2023

He had no concerns and he was doing well in school and with his friends. He had a sprained ankle the previous year that he says was well-healed. There is no positive association for deep venous thrombosis, cardiomyopathy, heart failure, stroke and no abnormalities of growth parameters in the pediatric population. Ann Intern Med.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Sensible Medicine

FEBRUARY 28, 2024

He is a thoughtful well-read cardiologist. 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 46

Stroke Documentation/Coding Outcomes Wellness 46

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. Nachi: Well, I’m sure more of those studies are still coming. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Administration 40

ACEP Now

APRIL 2, 2024

They are found in large numbers in the mouth, throat, and stomach, as well as throughout the body. 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.

Burns 40

Burns Poisoning Seizures Stroke 40

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. 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. I do not know why she did not have a rapid rate.

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

MARCH 6, 2019

There is a new Q-wave in aVL, with STE and large T-wave as well. She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. The patient did well. 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. Nachi: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence.

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. Nachi: Recurrent and late onset coagulopathy after FabAV treatment has also been well described.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

There is some risk of stroke when converting atrial flutter. Wang: "A difficult case very well handled. Example: What happens when you give adenosine to a patient with this rhythm? But this is unlikely to be PSVT, so we did not use adenosine. Electrical cardioversion. We had no medical records. It was converted with ibutilide.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

EMDocs

JULY 20, 2023

Patient had to be able to be randomized between 6-24 hours after last known well. Pre-stroke disability had to be insignificant measured by mRS (modified Rankin Scale) of 0 or 1. Take away: Positive trial The study used superior imaging techniques and extensive stroke care that may not be readily available at smaller facilities.

Stroke 92

Stroke Outcomes Head Injuries Psychiatric 92

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

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.” I pretty much agree with the sentiment that statins are “well-tolerated” but what does that really mean?

Stroke 101

Stroke Outcomes Wellness Evidence-Based Practice 101

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are your differentials? Bad bronchiolitis ?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

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 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. 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

She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. 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. 2018 Nov;19(6):952-960.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

PulmCCM

FEBRUARY 3, 2025

Theoretical harms from excessive oxygen therapy include absorption atelectasis, acute lung injury, inflammation and tissue damage mediated by reactive oxygen species, as well as central nervous system, cerebrovascular and cardiovascular toxicity. IOTA First, consider the largest meta-analysis performed to date: IOTA (Chu et al, Lancet 2018).

Sepsis 52

Sepsis Stroke Outcomes Hospitals 52

PulmCCM

JANUARY 2, 2025

The ADAPT-Sepsis Trial Between 2018 and 2024 at 41 centers in the U.K., Conclusions Numerous randomized trials, most of them small and at risk for bias, previously suggested that procalcitonin-guided antibiotic discontinuation resulted not only in reduced antibiotic exposure in severe illness, but a tendency toward lower mortality as well.

Sepsis 98

Sepsis Outcomes Stroke Shock 98