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?
Emergency Department Outcomes Stroke 
Brazilian Butt Lift Procedure Can Result in Emergency Department Visits
ACEP Now
MAY 9, 2024
These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient. Plast Reconstr Surg.
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Goal-Oriented, Bundled Care For Intracerebral Hemorrhage Improves Outcomes
ACEP Now
OCTOBER 10, 2023
A 76-year-old female presents to the emergency department obtunded with left hemiplegia. The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Symptoms began just prior to presentation. Her blood pressure (BP) is 195/104 mmHg. Reference Ma LM, Hu X, Song L, et.
Outcomes 
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SGEM#450: Try Again – Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage
The Skeptics' Guide to EM
AUGUST 10, 2024
He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.
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Journal Feed Weekly Wrap-Up
EMDocs
MAY 4, 2024
. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation. 14795. . #2:
SGEM#290: Neurologist Led Stroke Teams – Working 9 to 5
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.
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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?
EMDocs
JANUARY 29, 2024
Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes.
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SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections
The Skeptics' Guide to EM
MARCH 2, 2024
Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.
Grand Rounds Recap 1.24.24
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
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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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SGEM#406: Homeward Bound…after a dose of Intranasal Fentanyl for Sickle Cell Vaso-occlusive Pain
The Skeptics' Guide to EM
JUNE 17, 2023
Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Reference: Rees CA et al.
REBEL Core Cast 97.0 – Acute Vision Loss II
RebelEM
MARCH 8, 2023
Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Emergency Department Management: Emergency ophthalmology consultation. et al, Emergency Medicine Clinical Essentials ed 2.
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Fourteen Emergency Medicine Research Gems from 2023
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?
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Intranasal Fentanyl for Sickle Cell Vaso-Occlusive Pain
ACEP Now
AUGUST 25, 2023
Intranasal Fentanyl for Sickle Cell Vaso-Occlusive Pain Case A 15-year-old female with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of her legs and back. Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes.
SGEM Xtra: This is My Life – Centralization of Rural Emergency Healthcare
The Skeptics' Guide to EM
APRIL 8, 2023
There have been many “temporary” rural emergency department closures during the past last year. In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. It was a stepped-wedge reconfiguration of the entire Danish emergency healthcare system.
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The Current Status of Continuous-Seizure Management
ACEP Now
JULY 7, 2024
1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings.
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SGEM#333: Do you gotta be starting something – like tPA before EVT?
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. JAMA 2021 Case: A 74-year-old woman presents to your emergency department with 1.5 JAMA 2021 * Zi et al.
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SGEM#325: Thin Ice – Subgroup Analysis of the THAWS Trial
The Skeptics' Guide to EM
APRIL 3, 2021
He is Head of the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research; Professor of Emergency Medicine, University of Western Australia; and Director of Research for Royal Perth Hospital. mg/kg) was beneficial for unknown onset stroke above a certain core size. Reference: Toyoda et al.
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SGEM Xtra: Here Comes the NINDS Again
The Skeptics' Guide to EM
JULY 9, 2022
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. Dr. Garg […] The post SGEM Xtra: Here Comes the NINDS Again first appeared on The Skeptics Guide to Emergency Medicine. BMC Med Res Methodol.
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REBEL Reflections Episode 5: Thinking in Bets – Making Better Decisions When You Don’t Have All the Facts
RebelEM
MARCH 13, 2024
This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. As doctors working in Emergency Medicine we often have to do the same thing and the wrong decision could potentially be fatal!
Episode 31 - Emergency Department Management of Patients Taking Direct Oral Anticoagulant Agents (Pharmacology CME)
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.
Epi vs. NorEpi | EVT for BAO | High-dose IN Fentanyl | Post-thrombectomy tPA | Stress of the Stress Test
JournalFeed
MARCH 26, 2022
High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.
Subarachnoid hemorrhage: ED presentation, evaluation, and management
EMDocs
JULY 3, 2023
Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. The patient is in no acute distress.
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Episode 20 - Emergency Department Management of North American Snake Envenomations
EB Medicine
SEPTEMBER 1, 2018
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.
The Latest in Critical Care, 2/26/24 (Issue #31)
PulmCCM
FEBRUARY 26, 2024
Tenecteplase for acute ischemic stroke presenting after 4.5 Because it can be infused more rapidly than alteplase, TNK is gaining prominence as thrombolytic treatment for acute ischemic stroke, in patients presenting within 4.5 hours post-stroke, but those trials were conducted before mechanical thrombectomy (performed a.s.a.p.
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SGEM#310: I Heard A Rumour – ER Docs are Not Great at the HINTS Exam
The Skeptics' Guide to EM
DECEMBER 5, 2020
Case: A 50-year-old female presents to your community emergency department in the middle of the night with new-onset constant but mild vertigo and nausea. You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke.
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SGEM#270: CRASH-3 TXA for Traumatic Head Bleeds?
The Skeptics' Guide to EM
OCTOBER 14, 2019
He arrives at the emergency department via EMS with a Glasgow Coma Scale (GCS) score of 10 and both pupils reactive. The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. Case: A 42-year-old man falls off a backyard deck. He is hemodynamically stable and sent for a STAT head CT.
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Grand Rounds Recap 12.6.23
Taming the SRU
DECEMBER 6, 2023
artiga and stothers After concern for stroke is identified, pursue neuroimaging (non-contrast CT head and CT angio head/neck) within 25 minutes of patient arrival to the ED to differentiate between a hemorrhagic or ischemic process. With rare exception, patients with sICH should be admitted to a specialized stroke unit (NSICU).
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SGEM#301: You Can’t Stop GI Bleeds with TXA
The Skeptics' Guide to EM
SEPTEMBER 19, 2020
We were trying to answer the question: Do all patients presenting to the emergency department with chest pain need to be placed on cardiac monitoring or could some be safely removed? TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ). The CRASH-2 trial showed a 1.5%
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A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!
Dr. Smith's ECG Blog
DECEMBER 26, 2020
On arrival to the PCI center's Emergency Department, the receiving team recorded an ECG on arrival: Persistent atrial flutter, however this time the QRS occurs on a slightly different portion of the flutter wave. The patient was admitted for stroke management. Long-term outcome is unknown. Serial troponins were negative.
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Grand Rounds Recap 4.19.23
Taming the SRU
MAY 1, 2023
A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).
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SGEM#322: TXA for SAH – Won’t Stop Me Now
The Skeptics' Guide to EM
MARCH 13, 2021
Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ).
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Top 10 Things I Learned at #ALLOhioEM19
All Ohio EM
FEBRUARY 11, 2019
It’s still going to take a while for this product to make its way to all emergency departments. Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. Even once it arrives, it will cost upwards of $25k per dose! NNT 7, NNH 19.
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Grand Rounds Recap 8.16.23
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% 2015) reported a sensitivity of 98.9%
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Grand Rounds Recap 4.5.23
Taming the SRU
APRIL 13, 2023
stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.
How To Manage Tracheo-Innominate Fistula
ACEP Now
MARCH 14, 2024
A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. Tracheo-innominate artery fistula after stroke. He has had a tracheostomy for approximately 15 months since his injury. NMC Case Report Journal.
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What happens when you give adenosine to a patient with this rhythm?
Dr. Smith's ECG Blog
AUGUST 23, 2017
Same stroke precautions as atrial fib
Stroke 52
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Glasgow Coma Scale in Children
Pediatric EM Morsels
JULY 21, 2023
Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Ann Emerg Med. PMID: 4136544.
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Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest
ACEP Now
JULY 7, 2023
emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 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.
2021 Wrap-Up
EM Literature of Note
JANUARY 9, 2022
The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?
Episode 28 - Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach
EB Medicine
MAY 3, 2019
This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt.
The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults
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. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.
EM@3AM: Hyperthermia
EMDocs
DECEMBER 16, 2023
An 18-month-old boy presents to the emergency department with loss of consciousness. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C.
Recognition and Treatment of Thrombotic Thrombocytopenic Purpura
ACEP Now
APRIL 5, 2024
2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. It is thus imperative that emergency physicians be able to recognize and properly treat this disease, especially in the absence of its classical presentation. Am J Emerg Med. J Emerg Med.
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