PulmCCM

MAY 3, 2024

While outcomes from acute ischemic stroke due to large vessel occlusion in the anterior circulation have improved substantially in the era of thrombolytics and mechanical thrombectomy, overall outcomes remain poor. ” However, that was in the era before mechanical thrombectomy. Along with endovascular thr… Read more

Stroke 52

Stroke Outcomes Hospitals 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

EMDocs

SEPTEMBER 8, 2024

Delaying treatment of elevated BP in patients may lead to worse outcomes, and an optimal IV antihypertensive medication will reach the BP goal rapidly while avoiding hypotension and causing end organ injury. Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. clevidipine).

Stroke 105

Stroke Outcomes Hospitals 105

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 101

Stroke Outcomes EMS Seizures 101

EMDocs

SEPTEMBER 3, 2024

Secondary: % change from baseline in anti-factor Xa activity during the first 2 hours from randomization Safety (assessed at 30 days): thrombotic events (ischemic stroke, VTE, myocardial infarction), mortality Results: 452 patients analyzed for the primary outcome. 530 patients analyzed for safety outcome. doi: 10.1161/STR.0000000000000407.

Stroke 98

Stroke Outcomes Hospitals 98

EMDocs

SEPTEMBER 2, 2023

. #1: Dual Antiplatelets or Lytics for Minor Stroke? Spoon Feed In minor acute ischemic stroke (AIS) patients presenting within 4.5 hours of onset, dual antiplatelet therapy (DAPT) is non-inferior to intravenous alteplase for excellent neurologic outcome at 90 days. 2022 Aug 1;93(2):157-165. Epub 2022 Mar 28. #3:

Stroke 96

Stroke Pediatrics Outcomes 96

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

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. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

The Skeptics' Guide to EM

AUGUST 10, 2024

A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73).

Stroke 90

Stroke Airway Management Documentation/Coding Outcomes 90

EMDocs

OCTOBER 21, 2023

Answer : Basilar Artery Occlusion Epidemiology:  Basilar artery occlusion (BAO) is a subset of the posterior circulation strokes. Posterior circulation strokes are estimated to account for 20% of all strokes, with BAO accounting for ~1% of all strokes. Symptoms may range from days to months prior to stroke onset.

EMS 98

EMS Stroke Outcomes Hospitals 98

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. The language used in the guidelines is important.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 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 Pediatrics Outcomes 145

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

JournalFeed

NOVEMBER 26, 2022

The JournalFeed podcast for the week of Nov 21-25, 2022. Wake Up Strokes Spoon Feed In patients presenting with ‘wake-up’ strokes, endovascular therapy improves functional outcomes, while intravenous alteplase may also provide a small beneficial impact. These are summaries from just 2 of the 5 article we cover every week!

CPR 40

CPR Stroke Outcomes 40

Taming the SRU

NOVEMBER 3, 2023

41, 2695–2701 (2022). 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.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

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. 2022 Sep 5. 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

The Skeptics' Guide to EM

JULY 9, 2022

Date: July 1st, 2022 Guest Skeptic: Dr. Ravi Garg is a Neurologist in the Department of Neurology, Division of Neurocritical Care at Loyola University Chicago. Risk of selection bias assessment in the NINDS rt-PA stroke study. 2022 Jun 15;22(1):172. Risk of selection bias assessment in the NINDS rt-PA stroke study.

Stroke 52

Stroke Emergency Department EMS Outcomes 52

Taming the SRU

FEBRUARY 24, 2024

ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive (..)

Leadership 94

Leadership EMS Pediatrics Stroke 94

EMDocs

MAY 15, 2024

2022 Aug;58:235-244. Epub 2022 Jun 11. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. Am J Emerg Med. PMID: 35717760.

Blood Transfusions 104

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 104

Don't Forget the Bubbles

FEBRUARY 5, 2025

According to the latest figures (2022), there were approximately 6,000 recorded offences where a child was a victim of violence, including physical assault, sexual abuse, and homicide. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

The Skeptics' Guide to EM

APRIL 8, 2023

In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. The main outcome was the adjusted odds ratio for in-hospital mortality and hazard ratio for 30-day mortality with some pre-specified subgroups.

Stroke 57

Stroke Emergency Department COPD Academics 57

PulmCCM

MAY 8, 2023

Read in JAMA Endovascular thrombectomy for large ischemic stroke came to prominence based on limited data showing its efficacy in patients with smaller strokes; large strokes were excluded. This was a noninferiority trial; remifentanil fell below the prespecified threshold for inferiority, though with a wide confidence interval.

Stroke 52

Stroke Hospice Blood Transfusions Anaphylaxis 52

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. Accessed 2022, [link]. Prehosp Emerg Care. Bell JM, Breiding MJ, DePadilla L. J Safety Res.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

EMDocs

MAY 28, 2024

2022 Aug;58:235-244. Epub 2022 Jun 11. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Underestimates alveolar hypoxemia. Am J Emerg Med. PMID: 35717760.

Blood Transfusions 98

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 98

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

EMDocs

NOVEMBER 20, 2023

For patients on VKAs to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor prothrombin complex concentrate (PCC) is preferred to fresh frozen plasma (FFP) because of the rapidity of INR reduction (Conditional recommendation, very low-quality evidence). Epub 2022 Sep 21. Am J Gastroenterol. PMID: 36735555.

Resuscitation 104

Resuscitation Fluid Resuscitation Hospitals Research 104

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

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 April 17, 2022 post ( Leads V1,V2 misplacement ).

Shock 97

Shock EKG/ECG Academics Stroke 97

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 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. Published May 11, 2022. Published online August 11, 2022:sjac224.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

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 116

EKG/ECG EMS Stroke Outcomes 116

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. He endorses nausea without vomiting and denies fever.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

APRIL 5, 2024

1 However, many clinical features are common: more than 60 percent of patients present with a degree of neurological involvement, ranging from confusion to stroke and coma. Thus, early management is essential for patient outcomes. Treasure Island (FL): StatPearls Publishing ;2022. 1 Dr. Am J Obstet Gynecol. 2009;200(4):381-e1.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Left ventricular end-diastolic volume: 99 ml. Left ventricular systolic volume: 49 ml. Left ventricular ejection fraction:50 %. Normal wall thickness. References: 1.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

Pediatric Education

MARCH 3, 2024

Long term, infants have higher risks of hypertension, stroke and increased body mass index. Preeclampsia and neonatal outcomes in adolescent and adult patients. doi:10.25122/jml-2022-0264 Dimitriadis E, Rolnik DL, Zhou W, et al. Pregnancy Hypertens. 2018;12:11-15. doi:10.1016/j.preghy.2018.02.003 J Med Life. Pre-eclampsia.

Pediatrics 40

Pediatrics Seizures Wellness Stroke 40

Taming the SRU

APRIL 13, 2023

2022 Pre-AeRATE Trial: use of HFNC for preoxygenation and apneic oxygenation showed no difference in lowest SpO2 during first intubation attempt when compared with usual care. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

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]. 2022 Jul 11;11(14):2163. 2022 Jan;28(1):13-22. Medicine (Baltimore). 2020 Nov 20;99(47):e23315.

Infectious Diseases 89

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