EMDocs

JUNE 8, 2023

This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 77

Stroke Administration Outcomes Documentation/Coding 77

The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. The Lancet March 2019. Date: September 25th, 2019 Reference: Bath PM et al.

Stroke 52

Stroke Hospitals EMS Outcomes 52

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

The Skeptics' Guide to EM

APRIL 25, 2020

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. There is no previous history of stroke. We have covered acute ischemic stroke many times on the SGEM.

Stroke 40

Stroke Emergency Department Outcomes Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 26, 2019

Date: February 4th, 2019 Guest Skeptic: Dr. Jerome Hoffman is a Professor Emeritus of Medicine and Emergency Medicine, University of California, Los Angeles. Date: February 4th, 2019 Guest Skeptic: Dr. Jerome Hoffman is a Professor Emeritus of Medicine and Emergency Medicine, University of California, Los Angeles.

Stroke 52

Stroke EMS Research Outcomes 52

The Skeptics' Guide to EM

APRIL 4, 2020

It was the EBM rumble down under for SMACC 2019. You can see the original SGEM […] The post SGEM Xtra: The REBEL vs. The SKEPTIC at SMACC 2019 first appeared on The Skeptics Guide to Emergency Medicine. It was the EBM rumble down under for SMACC 2019. You can see the original SGEM Xtra post from March 2019.

CPR 52

CPR EMS Stroke Hospitals 52

The Skeptics' Guide to EM

MARCH 6, 2019

Date: February 18th, 2019 Guest Skeptic: Dr. Shahriar Zehtabchi is a tenured professor and Vice Chair of Academic Affairs in the Department of Emergency Medicine at SUNY Downstate Medical Center & Kings County Hospital. Testing the Presumption of Consent to Emergency Treatment for Acute Ischemic Stroke. JAMA 2014 * Banks and Marotta.

Stroke 40

Stroke Academics Hospitals Outcomes 40

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

AED Leader

SEPTEMBER 7, 2023

The teen suffered a spinal cord injury and a series of small strokes and is mostly paralyzed from the waist down. Sammy has catecholaminergic polymorphic ventricular tachycardia (CPVT), like his mother and his younger brother who passed away in 2019. However, he is “still himself” with some short-term memory loss.

CPR 52

CPR Stroke Hospitals 52

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. There were two intracranial hemorrhages in each group.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Mind The Bleep

FEBRUARY 5, 2024

Causes: central retinal artery occlusion/amaurosis fugax, central retinal vein occlusion, optic atrophy, trauma to the optic nerve, or orbital pathologies (e.g. If the quadrantanopia is inferior, the lesion is likely to be in the parietal lobe. Bibliography Gupta, M. and Bordoni, B. Neuroanatomy, Visual Pathway. online] PubMed. Visual Field Test.

Stroke 52

Stroke Operations 52

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 Hospitals 52

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 85

Seizures Stroke Outcomes EMS 85

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. Reference: Perry et al.

Emergency Department 52

Emergency Department Stroke EMS Academics 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

References Law YM, Lal AK, Chen S, Čiháková D, Cooper LT Jr, Deshpande S, Godown J, Grosse-Wortmann L, Robinson JD, Towbin JA; American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young and Stroke Council. Circulation. doi: 10.1161/CIR.0000000000001001.

Pediatrics 112

Pediatrics EKG/ECG Hospitals Burns 112

The Skeptics' Guide to EM

OCTOBER 14, 2019

Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators. The Lancet October 2019 Guest Skeptic: Dr. Salim Rezaie currently works as a community emergency physician at Greater San Antonio Emergency Physicians […] The post SGEM#270: CRASH-3 TXA for Traumatic Head Bleeds? first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 52

Stroke EMS Outcomes Emergency Department 52

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Date: September 18th, 2019 Reference: Scheuermeyer et al. AEM Sept 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Date: September 18th, 2019 Reference: Scheuermeyer et al. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 52

Emergency Department Academics Stroke Shock 52

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. NEJM 2019 Guest Skeptic: Dr. Ryan Radecki is an Emergency Physician at Kaiser Permanente NW, co-host of the Annals of Emergency Medicine podcast and Journal Club section editor. Date: April 5th, 2019 Reference: Connolly et al. You order a non-contrast CT to rule out hemorrhage.

Stroke 52

Stroke Administration EMS Wellness 52

Northwestern EM Blog

JUNE 16, 2024

The most common symptoms include: Lightheadedness Syncope Chest pain Exercise intolerance Fatigue **Important note: The heart rate at which patients experience symptoms may vary based on their ability to increase stroke volume. Hamilton, R. Joglar, J. Marine, J. McLeod, C. Patton, K. Pellegrini, C. Selzman, K. Thompson, A., & Varosy, P.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Mind The Bleep

JANUARY 11, 2024

Investigations include fundoscopy and fluorescein angiography. American Journal of Kidney Diseases. 2010;55(3):590-8. Bhagat N, Mehta J et al. Hypertensive Retinopathy. American Academy of Ophthalmology. National Institue for Health and Care Excellence. Hypertension in adults: diagnosis and management. Guidance NG136. GP notebook.

Stroke 52

Stroke Hospitals 52

PulmCCM

JANUARY 22, 2024

In 2019, the HYPERION trial (NEJM, n=584) found neurologic benefits of cooling to 33°C during the first 24 hours (compared to maintenance at 37°C). Also in 2019, the PRINCESS trial showed no improvement in neurologic outcome with nasal-evaporative cooling after cardiac arrest among 677 patients.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

The Skeptics' Guide to EM

MAY 24, 2019

Date: May 21st, 2019 Guest Skeptic: Dr. Andrew Worster is full professor at McMaster University and the creator of Best Evidence in Emergency Medicine (BEEM). Date: May 21st, 2019 Guest Skeptic: Dr. Andrew Worster is full professor at McMaster University and the creator of Best Evidence in Emergency Medicine ( BEEM ).

Domestic Violence 40

Domestic Violence Sexual Assault Research Diabetic Emergencies 40

Don't Forget the Bubbles

JUNE 30, 2023

Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. 2019 Nov 9;394(10210):1713-1723. Epub 2019 Oct 14. 2019 Nov 9;394(10210):1712. in the TXA group vs 53.7% in the placebo group). This study moves trauma care beyond just ‘survival’. What about head injury , though?

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. For treatment, the American Heart Association’s 2019 guidelines recommend limiting use of non-dihydropyridiine CCB due to potential for negative inotropic effects.

Outcomes 52

Outcomes Documentation/Coding Stroke Fractures 52

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. Thromb Res.

Administration 74

Administration Fractures Anaphylaxis Head Injuries 74

RebelEM

MAY 18, 2023

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Read more

Sepsis 89

Sepsis Shock Resuscitation Outcomes 89

PulmCCM

JANUARY 24, 2024

In 2019, the HYPERION trial (NEJM, n=584) found neurologic benefits of cooling to 33°C during the first 24 hours (compared to maintenance at 37°C). Also in 2019, the PRINCESS trial showed no improvement in neurologic outcome with nasal-evaporative cooling after cardiac arrest among 677 patients.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Pediatric Education

SEPTEMBER 3, 2023

A 2019 systematic review of SCT found that there is a risk for pulmonary embolism, proteinuria and chronic kidney disease (high-strength evidence). 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

The Skeptics' Guide to EM

MARCH 13, 2021

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. The results demonstrated that the Ottawa SAH Rule is highly sensitive (100%) but has very poor specificity (13%).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

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. For more on AFlutter — Please check out My Comment in the November 12, 2019 post and the May 1, 2023 post in Dr. Smith's ECG Blog ). Metoprolol was also on the medication list.

EKG/ECG 125

EKG/ECG Stroke Wellness Administration 125

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2019 Jul;20(7):660-666. 2019 Sep;241:112-118. Epub 2019 Apr 22. 2019 Jul;20(7):682-683. 2019): 478–483. Fun fact for animal lovers!- Pediatr Crit Care Med. doi: 10.1097/PCC.0000000000001938.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Mind The Bleep

FEBRUARY 12, 2024

Examples of causes of each are listed below. Suleiman, A.O., Boisvert, C.J., Othman, B.A., Justin, G.A. and Henderson, A.D. 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. and Lee, S.

Stroke 52

Stroke Pediatrics 52

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). She has no chest symptoms. What is the diagnosis? He stated he had never had this before.

EKG/ECG 106

EKG/ECG EMS Stroke Outcomes 106

EM Literature of Note

JULY 4, 2022

This article pertains to the practice of telestroke administration of thrombolysis for acute ischemic stroke. In major hospital centers, there may be in-house neurology hospitalists or stroke and vascular specialists, and the expertise for management of stroke is readily at the bedside. of their series are stroke mimics.

Stroke 40

Stroke Academics Hospitals Administration 40

Dr. Smith's ECG Blog

MARCH 19, 2019

Although the QT is very long, long QT due to hypocalcemia is rarely associated with Torsades de Pointes. == Comment by K EN G RAUER, MD ( 3/19/2019 ): == There are a number of ECG patterns that should immediately suggest a clinical diagnosis. Here was a repeat ECG: QTc 523. Long ST segment remains. This is one of them!

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

Dr. Smith's ECG Blog

MARCH 15, 2023

IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ). Ballatore et al — Medicina (Kaunas) 55(8): 497, 2019 — and — Page et al — Circulation 107:1141-1145, 2003 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52