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 132

Seizures Stroke Outcomes Research 132

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. Therefore, administration of IV morphine (A) would not be recommended. Low threshold for antibiotics and escalation of care with surgery consultation. What is the best next step in management?

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

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 87

Stroke Administration Outcomes 87

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 99

Stroke Outcomes EMS Seizures 99

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 98

Stroke Administration Outcomes Hospitals 98

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 97

EMS Stroke Outcomes Hospitals 97

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 97

Stroke Academics Outcomes Administration 97

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

ACEP Now

MARCH 11, 2025

First, UFH is often perceived as stronger than alternatives, partially owing to the intravenous route of administration. 11 Most patients hospitalized with PE undergo neither CDT nor thrombolysis and, even if they do, administration of LMWH is not a contraindication. Stubblefield WB, Helderman R, Strokes N, et al.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

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

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

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

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

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 74

Emergency Department Pediatrics Head Injuries Administration 74

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

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 113

EKG/ECG Stroke Administration Ultrasounds 113

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

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.

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. Administratively, CMS could convert SEP-1 to a “process”-based or “intermediate outcome measure” or another type. And have they fired.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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

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 80

Administration Fractures Anaphylaxis Head Injuries 80

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

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

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). Strong recommendation, moderate quality evidence).

Resuscitation 104

Resuscitation Fluid Resuscitation Hospitals Research 104

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), Vital signs were within normal limits on arrival to the Emergency Department. Blood glucose was not low at 162 mg/dL. or basilar ischemia.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

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

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. the subsequent hospitalization rate was around 10%.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

EMDocs

OCTOBER 30, 2023

In acute ICM contrast shortages, a tier-based necessity system may preserve contrast for emergent studies such as stroke, hemodynamically unstable trauma, aortic dissection, AAA rupture, active GI bleed, PE, acute mesenteric ischemia, etc. Contrast Media, Iodinated, Dose, and Administration. J Am Coll Radiol. doi:10.1016/j.jacr.2023.06.032

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

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

Critical Care Now

MAY 12, 2022

The Pre-brief When we think of lysing things in the emergency department (ED), we think of alteplase busting up a blood clot in either ischemic stroke or in patients experiencing a massive pulmonary embolism. Interests include trauma, toxicology, and infectious diseases. Another lytic that is used in the ED is docusate for cerumen impaction.

Infectious Diseases 52

Infectious Diseases Stroke Emergency Department Administration 52

RebelEM

MARCH 22, 2023

An alternate administration approach can be found on ALiEM. Valsalva maneuvers Have patient bear down as if they are having a bowel movement Have patient blow as hard as they can into a straw Syringe technique Postural Modification Success rate: 43% vs. 17% (standard Valsalva) (Appleboam 2015) Details of technique found at the St.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

PulmCCM

DECEMBER 11, 2024

This is “burying the lede” The fact that we can’t define sepsis (and never could) is critical because it injects uncertainty (you can debate how much) into every published clinical study (as compared to, say, trials on ischemic stroke, myocardial infarction, or cancer).

Sepsis 45

Sepsis Shock Research Wellness 45

PulmCCM

JANUARY 4, 2022

For example, should a fluid challenge fail to raise stroke volume [SV], a state of physiological preload intolerance exists and additional volume is arguably harmful ; further attempts to increase tissue perfusion might then be best achieved with vasoactives. For what are intravenous fluids diagnostic?

Wellness 40

Wellness Outcomes Sepsis Stroke 40