RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 140

Administration Outcomes Resuscitation Radiology 140

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 125

Seizures Stroke Outcomes Research 125

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 134

Stroke Outcomes Hospitals Administration 134

EMDocs

AUGUST 17, 2024

. #1: TNK Up to 24 Hours for Stroke? 24 hours after onset, without access to endovascular thrombectomy (ET), tenecteplase(TNK) administration bested standard medical treatment(SMT) in 90-day disability-free recovery. Source Tenecteplase for Ischemic Stroke at 4.5 3: Can We Use Lytics for Stroke Patients on a DOAC?

Stroke 70

Stroke Administration Outcomes 70

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

EMDocs

AUGUST 13, 2024

Administration of IV antihypertensives in the absence of HTN emergency is not recommended. However, ff SBP is > 180 or DBP is > 110-120 mm Hg and the patient does have new or worsening target organ damage, the patient has HTN emergency.

Stroke 85

Stroke Administration Outcomes Hospitals 85

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. Myth busting: Is peripheral administration safe? 2021;25(1):146.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

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

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

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. avoided a CVC entirely. 2023, doi:10.1016/j.chest.2023.08.019

Stroke 63

Stroke Administration Outcomes 63

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? Article: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

RebelEM

SEPTEMBER 28, 2023

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

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

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 74

EMS Stroke Outcomes Hospitals 74

EMDocs

SEPTEMBER 6, 2023

Learning points: Consider differential – sepsis, thyroid storm, thalamic stroke, exertional and classic heat stroke, serotonin syndrome, neuroleptic malignant syndrome, sympathomimetic toxicity, and anticholinergics. Reference: EM@3AM – Heat Stroke Case 2: 40-year-0ld female feels unwell but no other specific complaints.

Anaphylaxis 71

Anaphylaxis Shock Sepsis Stroke 71

The Skeptics' Guide to EM

JUNE 17, 2023

The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7] IN fentanyl has been safely used to treat pain in pediatric patients.

Emergency Department 72

Emergency Department Pediatrics Head Injuries Administration 72

Sensible Medicine

NOVEMBER 28, 2023

People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators. [i] The primary outcome was stroke or systemic embolism and the primary safety outcome was major bleeding. years, anticoagulation reduced the rate of stroke or systemic embolism by 1.7% (HR: 0.63; 0.45

Stroke 70

Stroke Academics Outcomes Administration 70

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

The Skeptics' Guide to EM

JANUARY 1, 2022

Prospective, multicenter, controlled trial of mobile stroke units. Date: December 21st, 2021 Guest Skeptic: Dr. Prospective, multicenter, controlled trial of mobile stroke units. Background: No one who has listened to the SGEM will be surprised we are covering another paper looking at stroke. Reference: Grotta JC et al.

Stroke 52

Stroke EMS Outcomes Administration 52

ACEP Now

MARCH 6, 2024

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. What’s New in Stroke Care?

Research 52

Research Airway Management Stroke Outcomes 52

ACEP Now

SEPTEMBER 6, 2024

This comes out of INTERACT-4, a trial testing the efficacy of blood pressure reduction in undifferentiated acute stroke syndromes. Without delving into too much detail, approximately half of the over 2,300 patients in the trial suffered ischemic stroke, and the remainder hemorrhagic stroke.

Research 49

Research Stroke Outcomes Sepsis 49

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 114

CDC Radiology Radiology Outcomes 114

The Skeptics' Guide to EM

JUNE 5, 2021

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. Background: Management of acute ischemic stroke has been discussed on the SGEM ever since this knowledge translation project was launched in 2012.

Urgent Care 52

Urgent Care Stroke Critical Access Outcomes 52

Taming the SRU

FEBRUARY 12, 2024

Given her intracranial hemorrhages, significant attempts were made to improve coagulation including administration of IV vitamin K, 3 units of fresh frozen plasma, and administration of four-factor prothrombin complex concentrate (PCC, Kcentra). However, crucially, this assay must be calibrated to the agent of interest. [8]

Administration 78

Administration Fractures Anaphylaxis Head Injuries 78

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). Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke: Meta-Analysis of 5 Randomized Trials.

Stroke 52

Stroke Administration Outcomes 52

Emergency Medicine Ireland

APRIL 29, 2024

Hopefully what follows will provide enough broad brush strokes to get you through a night on call or even worse a viva. I will say that once the hypertonic is in and you’re reaching for a 2nd or a 3rd you should probably be thinking about a CVC as the access for administration and indeed regular sampling is really helpful.

Seizures 75

Seizures Sepsis Stroke Administration 75

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). Aspirin is sometimes given during the waiting period.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

The case was reviewed by the receiving team who had concerns for acute stroke or other cause of acute altered mental status. A CT angiogram of the head and neck was performed which showed a basilar artery thrombus which was concerning for brainstem stroke as the inciting cause. The patient was admitted for stroke management.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

PulmCCM

NOVEMBER 17, 2023

shows blood administration with a direct linear relationship between Pra and CO/VR; only Pmsf is varied here. For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. OP is operating point. See text for details. What does this mean?

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

Taming the SRU

FEBRUARY 24, 2024

non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 92

Leadership EMS Pediatrics Stroke 92

Dr. Smith's ECG Blog

JULY 5, 2024

But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. We want to avoid a stroke. They chose to give adenosine, and this is what happened: Adenosine to verify flutter: flutter waves made obvious Not actually from this case. What AV nodal blocker should we give?

EKG/ECG 92

EKG/ECG Stroke Administration Wellness 92

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 100

Sepsis Shock Resuscitation Outcomes 100

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Background: The issue of thrombolytics for stroke has been debated since at least 1995. Date: May 19th, 2020 Reference: Yang P et al.

Stroke 40

Stroke EMS Administration Wellness 40

JournalFeed

APRIL 9, 2022

Spoon Feed: IV Vitamin C (IVVC) administration appeared to be safe and reduced overall mortality in this meta-analysis of critically ill patients, when given in higher doses and as monotherapy. These are summaries from just 2 of the 5 article we cover every week! Vit-C = good?

Stroke 40

Stroke Administration 40

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke). If so, could this be done safely? JAMA Neurol. 2021;78(3):338–345.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52