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 78

Stroke Administration Outcomes Documentation/Coding 78

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

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

Emergency Medicine Journal

MARCH 21, 2024

Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).

Stroke 52

Stroke Documentation/Coding EMS Hospitals 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 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

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 Administration 40

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

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. What is the role of transcranial dopplers in primary prevention of strokes? What strategies are useful for secondary stroke prevention?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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 120

Pediatrics EKG/ECG Hospitals Burns 120

RebelEM

FEBRUARY 8, 2024

to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 for every change in 1mmHg Higher BMI: aOR 1.04; 95% CI 1.01 to 1.09; p = 0.01 for an increase in 1 Increased Patient Age: aOR 1.31; 95% CI 1.30 to 1.37; p <0.01 for every 10 years Radial Arterial Line Location: aOR 1.74; 95% CI 1.16

Resuscitation 126

Resuscitation Outcomes EMS Sepsis 126

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

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. N Engl J Med 2019 , 381 (19), 1831-1842. 4, 8 Paper: Dahyot-Fizelier, C., Infect Control Hosp Epidemiol 2014 , 35 (8), 915-936. Dequin, P.

CDC 125

CDC Radiology Radiology Outcomes 125

Dr. Smith's ECG Blog

FEBRUARY 18, 2024

This could be easily overlooked since there is complete heart block, but recognizing the atrial arrhythmia may mean prescribing anticoagulation to prevent stroke. The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. The January 30, 2018 post — for PTA.

EKG/ECG 97

EKG/ECG Stroke 97

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). based on the NOR-TEST trial) 2019 Update: “It may be reasonable to choose tenecteplase (single IV bolus of 0.25-mg/kg,

Stroke 52

Stroke Administration Outcomes 52

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). Stroke: causes and clinical features. 15 , 671–683 (2019).

Stroke 88

Stroke 88

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

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

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. 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

Administration 145

Administration Outcomes Resuscitation Radiology 145

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

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

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 Stroke Academics Shock 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine. Reference: Putzu et al.

Sepsis 52

Sepsis Shock Outcomes Stroke 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

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 105

Sepsis Shock Resuscitation Outcomes 105

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

Dr. Smith's ECG Blog

JANUARY 9, 2024

Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.

EKG/ECG 107

EKG/ECG Stroke Hospitals Documentation/Coding 107

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Epub 2019 Jul 3. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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 130

EKG/ECG Stroke Administration Wellness 130

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

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Outcomes Research 98

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 79

Administration Fractures Anaphylaxis Head Injuries 79

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

Dr. Smith's ECG Blog

OCTOBER 25, 2023

) — but I’ve enjoyed being able to get very close to computer-calculated QTc values by this simple correction factor method. PEARL #5: Over the years, I have found recall of a short LIST of Causes of QT Prolongation to be of invaluable assistance. Which of the 3 Causes in the above LIST are Likely?

EKG/ECG 120

EKG/ECG Seizures Hospitals Stroke 120

The Skeptics' Guide to EM

MAY 30, 2020

It seems to work for epistaxis ( SGEM#53 and SGEM#210 ), failed to demonstrate a decrease in all-cause mortality in post-partum hemorrhage ( SGEM#214 ), and did not result in an improved neurologic outcome in hemorrhagic strokes ( SGEM#236 ). It is unclear if it provides a benefit for gastrointestinal bleeds (GIB). TXA vs. 19.8%

Head Injuries 52

Head Injuries Academics Outcomes EMS 52

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.), Vital signs were within normal limits on arrival to the Emergency Department. Blood glucose was not low at 162 mg/dL. or basilar ischemia.

EKG/ECG 106

EKG/ECG Documentation/Coding Emergency Department COPD 106

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

PEARL #2: The principal abnormal finding on this ECG is QT prolongation , here with generalized nonspecific ST-T wave abnormalities. Over the years, I have found recall of a short LIST of Causes of QT Prolongation to be of invaluable assistance.

Seizures 111

Seizures EKG/ECG EMS Stroke 111