EM@3AM: Brainstem Strokes
EMDocs
MAY 11, 2024
Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?
What's the ideal blood pressure target after ischemic stroke?
PulmCCM
SEPTEMBER 21, 2023
Blood pressure often rises during acute ischemic strokes, in what is widely held to be a natural protective mechanism: increased blood pressure pushes more blood through and around stenotic blood vessels into areas of injured, oxygen-starved brain.
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Non-significant Studies Can Teach A Lot
Sensible Medicine
NOVEMBER 6, 2023
Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The original SWISS APERO trial results came in 2021. These are nice ideas. These are nice ideas.
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Unpacking the PEACH Trial: What is Levetiracetam’s Role in Spontaneous Intracerebral Hemorrhage?
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 ). However, guidelines offer no strong recommendations for its use, specifically in spontaneous ICH ( Fang 2021 ). Epub 2021 Jul 20. Neurocrit Care.
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On-scene times during ambulance assessment of suspected stroke patients across England from December 2021 to November 2022
Emergency Medicine Journal
SEPTEMBER 25, 2024
Ambulance crew’s main focus during stroke care is symptom recognition and rapid transport to specialist units to maximise access to and effectiveness of time-critical treatments. 4 In 2022, the Getting It Right First Time (GIRFT) stroke report 5 recommended an OST of less than 30 min for English ambulance services.
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Glasgow Coma Scale in Children
Pediatric EM Morsels
JULY 21, 2023
Gag reflex is much better predictor (45% vs 6%) [Conzelmann 2021] Positive predictive value of GCS indicating aspiration in intoxication was only 3%. BMJ Open 2021; 11: e053619. doi: 10.1136/bmjopen-2021-053619 Orso D, Vetrugno L, Federici N, D’Andrea N, Bove T. 2021 Jan 1;90(1):21-26. 2008 Apr;39(4):1347-8.
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SGEM#330: Should You Be Going Mobile to Treat Acute Ischemic Stroke?
The Skeptics' Guide to EM
MAY 15, 2021
Date: May 6th, 2021 Guest Skeptic: Dr. 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. Reference: Fatima et al.
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CT v MRI Stroke | Outpatient PE | VISI RCT | Prehospital TXA TBI | Misunderstanding Match Day
JournalFeed
JANUARY 23, 2021
It’s the JournalFeed Podcast for the week of Jan 18-22, 2021. We cover CT vs MRI for stroke, outpatient management of PE, VISI RCT VL vs DL for infant intubation, prehospital TXA for TBI, and how not to make your NRMP rank order list.
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EM@3AM: Stercoral Colitis
EMDocs
JANUARY 11, 2025
A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Admission is recommended for these patients for monitoring, given the high risk of progression to bowel necrosis, ulceration, perforation, and sepsis. Cureus 15(5): e39179. doi:10.7759/cureus.39179 Carlson, J.
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SGEM Xtra: The NNT is Mellow Yellow for tPA in Acute Ischemic Stroke
The Skeptics' Guide to EM
MAY 1, 2021
Date: April 30th, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com. Date: April 30th, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com.
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Remote Consult Protocols for Retinal Artery Occlusion: A Visionary Approach in Emergency Care?
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.
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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?
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.
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2021 Wrap-Up
EM Literature of Note
JANUARY 9, 2022
link] Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke Stopped early due poor outcomes in patients receiving alteplase prior to endovascular therapy.
First10EM Journal Club: December 2023
Broome Docs
DECEMBER 9, 2023
Does BP management in haemorrhagic stroke matter? 2021 Jun 15;72(12):2095-2100. Does BP management in haemorrhagic stroke matter? Welcome to another episode of the Emergency Medicine Journal Club with Dr Justin Morgenstern. How good is my intuition about PE diagnosis? Clin Infect Dis. doi: 10.1093/cid/ciaa395.
The Approach to Neuromuscular Weakness
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). University of Cincinnati MediaSpace [link] (2021).
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SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU
The Skeptics' Guide to EM
JANUARY 1, 2022
Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. Prospective, multicenter, controlled trial of mobile stroke units. NEJM 2021 […] The post SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU first appeared on The Skeptics Guide to Emergency Medicine.
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SGEM#349: Can tPA Be A Bridge Over Trouble Waters to Mechanical Thrombectomy?
The Skeptics' Guide to EM
NOVEMBER 6, 2021
Date: November 1st, 2021 Reference: Katsanos et al. Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs. Neurology 2021 Guest Skeptic: Dr. Michal Krawczyk is in his fifth year of neurology residency at Western University in London, Ontario, Canada.
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EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update
Emergency Medicine Cases
JANUARY 18, 2022
The post EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update appeared first on Emergency Medicine Cases.
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Sepsis alerts work! Just not in the patients who fire the alerts
PulmCCM
JANUARY 6, 2025
A 2021 analysis of Epic’s sepsis model revealed atrocious false positive and negative rates. The SCREEN Trial SCREEN was a stepped-wedge cluster randomized trial of an EMR alert for organ failure, conducted at 45 wards of 5 hospitals in Saudi Arabia from 2019 to 2021. 2021 Aug 1;181(8):1065-1070. 2021 Aug 1;181(8):1144.
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SGEM#333: Do you gotta be starting something – like tPA before EVT?
The Skeptics' Guide to EM
JUNE 5, 2021
Date: May 25th, 2021 Guest Skeptic: Dr. Garreth Debiegun is an emergency physician at Maine Medical Center in Portland, ME and clinical assistant professor with Tufts University School of Medicine. JAMA 2021 * Zi et al. JAMA 2021 Case: A 74-year-old woman presents to your emergency department with 1.5
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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock
Don't Forget the Bubbles
NOVEMBER 27, 2023
The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Published 2021 Apr 16. 2021;25(1):146. link] Roland D.
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Cottage Rehabilitation Hospital Honored by Mayor Murillo
Medical Law
NOVEMBER 2, 2021
Cottage Rehabilitation Hospital (CRH) was one of four local organizations honored during the 16 th annual Santa Barbara Mayor’s Award ceremony by Mayor Cathy Murillo on Thursday, October 28, 2021. CRH, along with the CRH Foundation, received the 2021 Design/Accessibility Award. The CRH Foundation.
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Patient-Centered Dx | tPA Pre-Endovascular | Steroids RPA | LP Febrile Seizure | AHA Chest Pain
JournalFeed
DECEMBER 11, 2021
It’s the JournalFeed Podcast for the week of December 6-10, 2021. We cover patient-centered diagnostic excellence, alteplase before endovascular stroke treatment, steroids for pediatric retropharyngeal abscess, LP for febrile seizure, and the new AHA chest pain guideline.
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POCUS Dyspnea | FQ+Aortic Disease | ASA-only Cervical Arterial Dissection? | CARPE DIEM | BASICS RCT
JournalFeed
JUNE 19, 2021
It’s the JournalFeed Podcast for the week of Jun 14-18, 2021. We cover POCUS for acute dyspnea, risk of fluoroquinolones in known aortic disease, aspirin or oral anticoagulants for cervical arterial dissection, predicting pneumonia severity in children, and endovascular therapy for basilar artery occlusion stroke.
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Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia
Dr. Smith's ECG Blog
APRIL 2, 2024
Angiogram in 2021 was normal. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 "Old records still had not appeared. Could not obtain a previous 12-lead ECG even by calling the U.
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Non-Invasive Blood Pressure Monitoring in Critically Ill Adults?
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
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The Case to Replace Alteplase
Downeast Emergency Medicine
OCTOBER 1, 2021
This lecture was presented at the 2021 Maine Medical Center Winter Symposium. 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). 2019 Aug;50(8):2156-2162.[ Full Print ]
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Is a Cuff Enough?
Taming the SRU
APRIL 17, 2024
Results They studied 1852 patients in the MICU with the most common admission diagnoses being respiratory failure (34 %), sepsis (23 %), and primary CNS disease such as stroke or hemorrhage (23 %). Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49:e1063-e1143.
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The Latest in Critical Care, 1/22/24 (Issue #26)
PulmCCM
JANUARY 22, 2024
The largest-yet TTM2 trial (NEJM 2021, n=1,900) tested temperature reduction to 33°C in all out of hospital cardiac arrests, and found no benefit compared to controls who received active fever prevention (application of automated cooling if core temperature reached 37.8°C °C despite acetaminophen, etc).
Intranasal Fentanyl for Sickle Cell Vaso-Occlusive Pain
ACEP Now
AUGUST 25, 2023
link] Published May 2021. Am J Hematol. Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine. References Campbell F, Hudspith M, Choinière M, et al. An action plan for pain in Canada. Health Canada website. Accessed August 8, 2023. National Heart Lung, and Blood Institute.
SGEM#376: I Wonder Why She Ran Away from the HINTS Exam
The Skeptics' Guide to EM
SEPTEMBER 17, 2022
AEM 2021 Guest Skeptic: Dr. Peter Johns has been practicing emergency medicine since 1985 and has been passionate about vertigo education for the last two […] The post SGEM#376: I Wonder Why She Ran Away from the HINTS Exam first appeared on The Skeptics Guide to Emergency Medicine. Date: September 16th, 2022 Reference: Gerlier C, et al.
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A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?
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. A number of potentially severe pulmonary complications t hat convey higher morbidity and mortality are commonly seen in patients with CTD ( Taha and Feteih — NIH, Skills in Rheumatology, 2021 ).
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The Latest in Critical Care, 3/18/24 (Issue #34)
PulmCCM
MARCH 18, 2024
PROPHY-VAP) Patients with strokes and traumatic brain injuries who require mechanical ventilation due to coma are at very high risk for developing ventilator associated pneumonia. These results line up with a 2021 meta-analysis, which found both midlines and PICCs had a CRBSI rate of about 0.5%. Alteplase or tenecteplase within 4.5
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SGEM#322: TXA for SAH – Won’t Stop Me Now
The Skeptics' Guide to EM
MARCH 13, 2021
Date: March 11th, 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Ohio. Lancet 2021 Case: You’re […] The post SGEM#322: TXA for SAH – Won’t Stop Me Now first appeared on The Skeptics Guide to Emergency Medicine. Reference: Post et al. Reference: Post et al.
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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
Stroke-volume:50 ml. Figure-2: Classification of Underlying Diagnoses in Patients with MINOCA ( Adapted from Table-1 in Sykes et al: Interventional Cardiology Review: 16:e10, 2021 ). Left ventricular end-diastolic volume: 99 ml. Left ventricular systolic volume: 49 ml. Left ventricular ejection fraction:50 %. Normal wall thickness.
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Major Trauma – Injuries by Assault
Don't Forget the Bubbles
FEBRUARY 5, 2025
It can cause significant internal injuries, including carotid artery dissection, stroke, and acquired brain injury, but in 50% of patients, there are no external signs of injury. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms. Don’t Forget the Bubbles, 2021.
Symptomatic Bradycardia: Considering the Differential Diagnosis
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. 2021, October 1). Journal of the American College of Cardiology , 74 (7), e51–e156. link] Farkas, J.
Diagnostics: Inflammatory Markers
Taming the SRU
AUGUST 30, 2023
Despite these results, the 2021 Surviving Sepsis guidelines recommend against using PCT to guide initiation of antimicrobial therapy due to multiple meta-analyses demonstrating no improvement in outcomes using PCT-guided antibiotic therapy [46,54]. 2021; 93: 4358–4369. 2021 Jan;25(1):466-479. Epub 2021 Oct 1. J Med Virol.
A young woman with epigastric pain. ECG Crochetage sign? What is the significance?
Dr. Smith's ECG Blog
JANUARY 8, 2020
A DDENDUM ( 5/8/2021 ) : Although descriptions vary in the literature that I've seen — true crochetage is said to occur on the upstroke of the R wave in inferior leads , occurring within the first 80 msec. See the 5 articles below. Our THANKS to Dr. Smith for presenting this case. STEVE — Is there any way to get follow-up on this case? =
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Targeted temperature management for post-cardiac arrest is officially over (for now)
PulmCCM
JANUARY 24, 2024
The largest-yet TTM2 trial (NEJM 2021, n=1,900) tested temperature reduction to 33°C in all out of hospital cardiac arrests, and found no benefit compared to controls who received active fever prevention (application of automated cooling if core temperature reached 37.8°C °C despite acetaminophen, etc).
Brazilian Butt Lift Procedure Can Result in Emergency Department Visits
ACEP Now
MAY 9, 2024
The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. Aesthetic Plastic Surgery National Databank Statistics 2020–2021.
An Unusual Bradycardia
Dr. Smith's ECG Blog
MAY 5, 2023
Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity. Narcan was not given at the scene.
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Emergency Medicine Deserves to “Re-Brand” Itself as a Cost Saver
ACEP Now
JULY 6, 2023
5 Patients with acute ischemic strokes, STEMIs, and trauma, as well as many other diagnoses, have their workup largely completed, and even sometimes definitive therapy executed, before they leave the emergency department, rather than requiring inpatient units. CDC website : Sexually Transmitted Disease Guidelines 2021. Postgrad Med.
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