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?
Sickle Cell Disease and Stroke
Pediatric EM Morsels
APRIL 7, 2023
Impact of the New American Heart Association/American Stroke Association Definition of Stroke on the Results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial. J Stroke Cerebrovasc Dis. 2017 Jan;26(1):108-115. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.038.
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EM@3AM: Cerebellar Stroke
EMDocs
JUNE 3, 2023
Answer : Cerebellar Stroke Epidemiology: 1-4% of cerebrovascular accidents occur in the cerebellum. 2 In the United States, approximately 795,000 people suffer from strokes every year. 3 Cerebellar strokes are associated with high morbidity and mortality. CT head without contrast 1 reveals the following: What is the diagnosis?
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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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First10EM Journal Club: December 2023
Broome Docs
DECEMBER 9, 2023
Does BP management in haemorrhagic stroke matter? 2023 Nov 6. 2023 Nov 6. 2023 Oct 12. 2023 Aug;35(4):605-611. 2023 Aug 7:e233264. 2023 May 30:S1538-7836(23)00438-5. 2023 Nov;73:182-186. 2023 Mar 23;388(12):1092-1100. How good is my intuition about PE diagnosis? JAMA Intern Med.
The ARAMIS Trial: DAPT vs Alteplase in Minor Nondisabling Acute Ischemic Stroke
RebelEM
JULY 27, 2023
Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke.
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Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke: multicentre, open label, randomised, controlled trial
EM Ottawa
JANUARY 2, 2024
2023 Oct 9;383:e076448. Question: Do early vs delayed blood pressure management in patients with mild-moderate acute ischemic strokes decrease death or dependency at 90 days? Methodology: 4/5 Usefulness: 2/5 Liu L, et al. Methods: Randomization to early (24 hrs) vs delayed treatment (after 7 days) of blood pressure.
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Stroke In Pregnant and Postpartum Patients- An Interview With Dr Srinivansan
EB Medicine
JANUARY 18, 2024
In this episode, Sam Ashoo, MD, interviews Vasisht Srinivasan, MD, FACEP one of the authors of the December 2023 Emergency Medicine Practice EXTRA article, Emergency Department Management of Stroke in Pregnant and Postpartum Patients Epidemiology Evidence Causes Risk Factors Differential Diagnosis Prehospital Care ED History and Physical Exam (..)
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AF Duration? Another Big Story from 2023
Stop and Think
DECEMBER 29, 2023
For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. Edoxaban reduced the primary endpoint of stroke, systemic embolism, and cardiovascular death by 19% (HR, 0.81; 95% CI, 0.60-1.08; hours) to edoxaban vs placebo. I don’t know.
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Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion
EM Ottawa
MAY 6, 2024
2023 Jun 1;388(22):2025-2036. Editorial: Expanding Treatment for Acute Ischemic Stroke beyond Revascularization. N Engl J Med.
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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. May 18, 2023) Stercoral Colitis: A Diagnostic Challenge and Therapeutic Approach in an Elderly Patient With Chronic Constipation. 2023 Oct;48(10):3050-3062. Epub 2023 Jun 27. In StatPearls.
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2023 Critical Care Year in Review (Part 1)
PulmCCM
DECEMBER 11, 2023
Cardiovascular care, strokes Mechanical thrombectomy was shown to markedly improve functional independence after large ischemic strokes ( SELECT2 ), heralding a new standard of care for the condition.
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Early versus Later Anticoagulation for Stroke with Atrial Fibrillation
EM Ottawa
MAY 20, 2024
2023 Jun 29;388(26):2411-2421. Question and Methods: RCT at 103 sites to compare outcomes at 30 days for early versus late DOAC initiation among patients with ischemic stroke and atrial fibrillation. Methodology: 3/5 Usefulness: 2/5 Fischer U, et al. N Engl J Med.
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Corticosteroids for ischemic stroke (MARVEL trial)
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. Studies in animal models have suggested corticosteroids might reduce infarct size or extension of subsequent cerebral edema.
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Journal Feed Weekly Wrap-Up
EMDocs
AUGUST 17, 2024
. #1: TNK Up to 24 Hours for Stroke? Source Tenecteplase for Ischemic Stroke at 4.5 3: Can We Use Lytics for Stroke Patients on a DOAC? Source Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants. 2023 Mar 1;80(3):233-243. 2023 Apr 1;80(4):422.
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ACEP’s Clinical Policy on Acute Ischemic Stroke
ACEP Now
MAY 9, 2024
The clinical policy on the management of adult patients presenting to the emergency department (ED) with acute ischemic stroke, was approved by the ACEP Board of Directors in April 2023. Developed by the ACEP Clinical Policies Committee, the guidance was published in the August 2023 issue of the Annals of Emergency Medicine.
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171. Cerebral Venous Thrombosis: Sneaky Strokes
Board Bombs
APRIL 2, 2023
What if we told you there was a type of stroke that affected young people, caused more seizures than "typical arterial strokes", and the typical ED imaging does not diagnose it. Cerebral Venous Thrombosis: Sneaky Stroke. link] April 3nd, 2023. Cerebral Venous Thrombosis: Sneaky Stroke. link] April 3nd, 2023.
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171. Cerebral Venous Thrombosis: Sneaky Strokes
Board Bombs
APRIL 2, 2023
What if we told you there was a type of stroke that affected young people, caused more seizures than "typical arterial strokes", and the typical ED imaging does not diagnose it. Cerebral Venous Thrombosis: Sneaky Stroke. link] April 3nd, 2023. Cerebral Venous Thrombosis: Sneaky Stroke. link] April 3nd, 2023.
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EM@3AM: Basilar Artery Occlusion
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.
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How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments
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).
Journal Feed Weekly Wrap-Up
EMDocs
OCTOBER 14, 2023
. #1: What’s the BEST Target SBP Post-Embolectomy for Stroke? Spoon Feed More aggressive systolic blood pressure (SBP) goals, beyond keeping it <180 mmHg, probably don’t make much of a difference in outcomes for patients who have undergone endovascular therapy for ischemic stroke. 2023 Sep 5;330(9):821-831. 2023.14330. #2:
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Journal Feed Weekly Wrap-Up
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 Source Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke: The ARAMIS Randomized Clinical Trial. 2023 Jun 27;329(24):2135-2144. 2023.7827. #2:
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Journal Feed Weekly Wrap-Up
EMDocs
JANUARY 13, 2024
2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. 2023 Nov 1;51(11):1449-1460. Epub 2023 Jun 9. #3: Source Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. 2023 Nov 11;402(10414):1753-1763. Emerg Med J.
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A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?
Dr. Smith's ECG Blog
NOVEMBER 11, 2023
A 90-something year old woman presented with an acute mild stroke. link] == MY Comment , by K EN G RAUER, MD ( 11/11 /2023 ): == From a learning standpoint — I LOVED this case because it illustrates in many ways how some patients simply "do not read the textbook before they come to the ED". This was shown to me in real time.
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Journal Feed Weekly Wrap-Up
EMDocs
MAY 4, 2024
Epub 2023 Sep 17. 2: The Endovascular Therapy Train Continues Onward Spoon Feed This was an exploratory analysis of the recently published SELECT2 trial, which randomized 352 adults with acute ischemic stroke due to carotid or M1 MCA occlusion to endovascular thrombectomy (EVT) or medical management. Acad Emerg Med. doi: 10.1111/acem.14795.
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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Medical Malpractice Insights: Excellent documentation supports standard of care and avoids lawsuit
EMDocs
FEBRUARY 28, 2024
Code Stroke is called and he is seen by a neurologist within 10 minutes. He is admitted with a diagnosis of brainstem stroke and treated by the neurologist with ASA only. I consulted [the tertiary stroke center] to try a thrombectomy… and the family understands that he is receiving tPA outside the usual window.”
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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Fourteen Emergency Medicine Research Gems from 2023
ACEP Now
MARCH 6, 2024
The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. What’s New in Stroke Care? The simplicity of tenecteplase administration makes its use likely the preferred agent for treating acute ischemic stroke. How Best to Stop the Bleeding in Trauma?
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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index
RebelEM
FEBRUARY 24, 2025
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. Mar 2023; PMID: 36983218 Feissel M, et al. Apr 2023; PMID: 37009935. Di Nicol P, et al.
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Journal Feed Weekly Wrap-Up
EMDocs
MAY 27, 2023
81,4 (2023): 453-465. 2022.10.020 #2: TRACE-2 RCT – Tenecteplase vs Alteplase for Stroke Spoon Feed Tenecteplase was non-inferior to alteplase in patients with acute ischemic stroke who were eligible for intravenous thrombolytic therapy but ineligible or refused endovascular thrombectomy. 2023 Feb 8;S0140-6736(22)02600-9.
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Glasgow Coma Scale in Children
Pediatric EM Morsels
JULY 21, 2023
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 1976 May 15;1(7968):1031-4. doi: 10.1016/s0140-6736(76)92215-7. PMID: 57446. Jain S, Iverson LM. Glasgow Coma Scale. Updated 2022 Jun 21]. In: StatPearls [Internet]. Available from: [link] Reilly PL, Simpson DA, Sprod R, Thomas L. 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345.
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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?
RebelEM
JANUARY 29, 2024
Clin Exp Emerg Med 2023. Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% in the paper but 2.7%
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The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock
RebelEM
SEPTEMBER 14, 2023
bleeding, stroke, limb ischemia, and hemolysis). The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. The evidence for this practice has been sparse until now. Zeymer HT et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. Control: 53.4% D ECLS: 18.2% Control 8.7%
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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. Treasure Island (FL): StatPearls Publishing; January 30, 2023.
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STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?
RebelEM
SEPTEMBER 28, 2023
STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. PMID: 37439219 Armstrong P et al.
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2024 AHA Scientific Statement on Management of Elevated Blood Pressure
EMDocs
AUGUST 13, 2024
HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years. Background Hypertension (HTN) is significant issue globally and a leading risk factor for cardiovascular disease. From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits.
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SAEM Clinical Images Series: Seeing Double
ALiEM
MARCH 22, 2024
The two main causes of internuclear ophthalmoplegia are demyelination of the medial longitudinal fasciculus (MLF) from multiple sclerosis (MS) and ischemic cranial nerve damage from stroke. Usually, MS is seen in younger patients where both eyes are affected whereas strokes occur more often in older patients and only one eye is affected.
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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?
RebelEM
JUNE 26, 2023
Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients with Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 PMID: 36942533 Innerhofer P et al.
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ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 2
PulmCCM
NOVEMBER 17, 2023
For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. Front Physiol 2023, 14:1230654. Crit Care 2023, 27(1):205. The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. What does this mean? References 1.
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SGEM Xtra: This is My Life – Centralization of Rural Emergency Healthcare
The Skeptics' Guide to EM
APRIL 8, 2023
Date: April 4th, 2023 Reference: Vaughan and Browne. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Date: April 4th, 2023 Reference: Vaughan and Browne. BMJ Qual Saf.
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Hypertensive Emergencies
EB Medicine
JUNE 1, 2023
In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the June 2023 Emergency Medicine Practice article, Hypertensive Emergencies: Guidelines and Best Practice Recommendations Epidemiology Etiology Differential diagnosis Prehospital care History and physical Diagnostics Treatment Acute decompensated heart failure Acute ischemic stroke Acute (..)
190. Cranial artery dissections and Boba tea
Board Bombs
SEPTEMBER 18, 2023
Lets talk about a scary, uncommon cause of stroke in young people. September 18th, 2023. Lets talk about a scary, uncommon cause of stroke in young people. September 18th, 2023. Want to experience the greatest in board studying? Cite this podcast as: Briggs, Blake; Husain, Iltifat. Cranial Artery dissection and Boba tea.
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190. Cranial artery dissections and Boba tea
Board Bombs
SEPTEMBER 18, 2023
Let’s talk about a scary, uncommon cause of stroke in young people. September 18th, 2023. Let’s talk about a scary, uncommon cause of stroke in young people. September 18th, 2023. Want to experience the greatest in board studying? Cite this podcast as: Briggs, Blake; Husain, Iltifat. Accessed [date]. Accessed [date].
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