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 ). About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ).

Seizures 123

Seizures Stroke Outcomes Research 123

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 91

Stroke Outcomes EMS Seizures 91

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Read More Core EM: CRASH-2: Tranexamic Acid in Major Trauma References: CRASH-2 Trial Collaborators.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 133

Stroke Outcomes Hospitals Administration 133

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. He has been practicing in Emergency Medicine for over 40 years and involved in EMS services for over 30 years.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

RebelEM

SEPTEMBER 28, 2023

appeared first on REBEL EM - Emergency Medicine Blog. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e.

EKG/ECG 137

EKG/ECG Allergic Reactions Shock Stroke 137

The Skeptics' Guide to EM

JANUARY 1, 2022

He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Prospective, multicenter, controlled trial of mobile stroke units. He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Howie also has a Master of Public Health.

Stroke 52

Stroke EMS Outcomes Administration 52

Taming the SRU

FEBRUARY 24, 2024

Sometimes even the smallest contributions can make the biggest difference in patient experience and overall ED quality. Early recognition and prompt treatment is key. non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 94

Leadership EMS Pediatrics Stroke 94

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. 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

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

Sepsis 99

Sepsis Shock Resuscitation Outcomes 99

Dr. Smith's ECG Blog

OCTOBER 12, 2024

With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. Vital signs were within normal limits on arrival to the Emergency Department. Blood glucose was not low at 162 mg/dL.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department COPD 117

ACEP Now

OCTOBER 3, 2023

This guideline revision is particularly timely as EMS systems have shown their abilities to dramatically improve survival and neurologic outcome after cardiac arrest, STEMI, acute stroke, and other time-sensitive conditions. References Lulla A, et al. Prehospital Guidelines for the management of traumatic brain injury – 3rd edition.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Managing editor of EM:RAP and Associate Editor at REBEL EM. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Managing editor of EM:RAP and Associate Editor at REBEL EM.

Stroke 40

Stroke EMS Administration Wellness 40

Taming the SRU

DECEMBER 6, 2023

ems grand rounds: southwest ohio protocol updates WITH dr. weekley Ideally, medications will be administered IV or IO, therefore endotracheal tube drug administration will be de-emphasized. If there is no improvement in 20 minutes, EMS will call medical control regarding further decisions.

Leadership 57

Leadership Stroke Airway Management Administration 57

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. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. Westendorp, W.

CDC 111

CDC Radiology Radiology Head Injuries 111

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. She stabilized after electrolyte administration with no further episodes of TdP. Written by Magnus Nossen — with edits by Grauer. The patient in today’s case is a 30-something female.

Seizures 114

Seizures EKG/ECG EMS Stroke 114

ACEP Now

MARCH 6, 2024

Gotta catch ‘em all!” The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome.

Research 52

Research Airway Management Stroke Outcomes 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

The EM provider asked if the cardiologist thought it was a "STEMI." The case was reviewed by the receiving team who had concerns for acute stroke or other cause of acute altered mental status. The patient was admitted for stroke management. There was again no intracranial hemorrhage. Serial troponins were negative.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 92

Radiology Radiology Emergency Department Hospitals 92

The Skeptics' Guide to EM

APRIL 6, 2019

He reports he has been taking apixaban to prevent stroke in the context of atrial fibrillation, which you easily recognize as one of the modern oral anti-Factor Xa inhibitors. This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran. Dabigatran is a direct thrombin inhibitor.

Stroke 52

Stroke Administration EMS Wellness 52

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. PCI) in STEMI Early administration of aspirin decreases mortality and complications of MI (all types). (19), Part 2 : Why do we care? Part 2 : Why do we care? *

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

RebelEM

MARCH 22, 2023

Amal Mattu’s ECG Blog has an excellent review of AVNRT vs. VT and REBEL EM reviews the sensitivity and specificity of various algorithms. An alternate administration approach can be found on ALiEM. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 98.0 – AVNRT appeared first on REBEL EM - Emergency Medicine Blog.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

ACEP Now

JULY 6, 2023

Emergency medicine (EM) has evolved over time and has long passed a crossroads where previously unachievable capabilities should be celebrated and shared. Acute pyelonephritis has become a disease for which outpatient management is often feasible and appropriate. 2 Technological changes have helped emergency physicians become more efficient.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Northwestern EM Blog

MAY 16, 2022

Finally, a burden on us as EM clinicians is training in and awareness of clinical practice guidelines and recommendations from specialties outside of EM. He endorses nausea without vomiting and denies fever. Please ensure that you document and discuss with the patient accordingly. J Urol 2019. 202(3):475-483.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

RebelEM

FEBRUARY 1, 2024

Background : Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. mg/kg non-inferior to alteplase in the treatment of acute ischemic stroke? vs Alteplase 34.8%

Stroke 132

Stroke Blood Transfusions Outcomes EMS 132

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

RebelEM

JUNE 12, 2024

1 Recall that cardiac output is a function of both stroke volume and heart rate. The natural response to diminishing stroke volume is a compensatory rise in heart rate (tachycardia). Rapid administration may induce nausea and emesis. Clin Toxicol (Phila). 2007;45(4):396-401.

Poisoning 95

Poisoning Stroke Shock Administration 95

EM Literature of Note

SEPTEMBER 9, 2021

It has apparently become time for the mobile stroke unit to go from niche to prime-time. Previously consigned to the pages of Stroke and similar journals, the latest and most comprehensive trial now graces the pages of the New England Journal of Medicine. of those with EMS. A flagship study for a flagship journal.

Stroke 40

Stroke Telemedicine EMS Administration 40

ACEP Now

AUGUST 25, 2023

The National Heart, Lung, and Blood Institute released an expert panel report in 2014 with evidence-based guidelines for management of SCD recommending timely administration of parenteral opioids for VOE.2 Two interesting findings were time to parenteral opioid administration and total dose of opioid morphine equivalents. Am J Hematol.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. Also, be aware that there are various formulations of cannabis that allow for different routes of administration. First up is the link between cannabis use and stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. 2017.04.011 Witt CE, Bulger EM. Authors: Nikhil B.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Dr. Smith's ECG Blog

APRIL 8, 2015

in 2010 EM Clinics of North America (full text link) For an Exhaustive Review of Syncope and its full management outside the ED environment, go to the 2009 European Society of Cardiology Guidelines (full text pdf). to 1.45) for fatal or nonfatal stroke. to 1.51) for death from any cause, 1.27 (95 percent confidence interval, 0.99

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EM Literature of Note

JANUARY 9, 2025

This is yet another one of those “Get With The Guidelines” stroke analyses, a retrospective dredge with massive imbalances between groups followed by statistical adjustments capable of turning out whichever result suits an author list with a full, dense printed page of pharma and stroke technology conflicts of interest.

Stroke 86

Stroke Documentation/Coding EMS Administration 86

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke 86

Stroke Administration COPD Dehydration 86