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 119

Seizures Stroke Outcomes Research 119

EMDocs

SEPTEMBER 8, 2024

Delaying treatment of elevated BP in patients may lead to worse outcomes, and an optimal IV antihypertensive medication will reach the BP goal rapidly while avoiding hypotension and causing end organ injury. Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. clevidipine).

Stroke 93

Stroke Outcomes Hospitals 93

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 130

Stroke Outcomes Hospitals Administration 130

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia?

COPD 95

COPD Stroke Academics Urgent Care 95

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. Arrangements are made for transfer by fixed-wing air, and he arrives 4 hours 15 minutes later [despite the receiving hospital being only 80 minutes away by freeway].

Documentation/Coding 92

Documentation/Coding Stroke Outcomes EMS 92

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Sensible Medicine

MAY 20, 2024

The authors chose a composite primary endpoint of three things: hemostatic efficacy as defined by expansion of the hematoma by 35% or less, an increase in the stroke scale called NIHSS by less than 7 points (0-42 scale), and no receipt of rescue therapy (like surgical drainage). Ischemic stroke occurred in 6.5% It was 10.3%

Stroke 114

Stroke Outcomes Hospitals Wellness 114

Sensible Medicine

JUNE 28, 2024

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. She is admitted with suspected stroke. There were no personal crises or untoward patient outcomes. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. I love my job.

Stroke 102

Stroke Academics EKG/ECG Hospitals 102

EMDocs

SEPTEMBER 3, 2024

Secondary: % change from baseline in anti-factor Xa activity during the first 2 hours from randomization Safety (assessed at 30 days): thrombotic events (ischemic stroke, VTE, myocardial infarction), mortality Results: 452 patients analyzed for the primary outcome. 530 patients analyzed for safety outcome.

Stroke 88

Stroke Outcomes Hospitals 88

RebelEM

SEPTEMBER 14, 2023

bleeding, stroke, limb ischemia, and hemolysis). to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Zeymer HT et al. Control: 53.4% D ECLS: 18.2%

Shock 130

Shock Outcomes Resuscitation Stroke 130

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. References Tsao CW, et al. Circulation. 2022;145(8):e153-e639.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

The Skeptics' Guide to EM

MARCH 2, 2024

He is the Vice Chair of the Emergency Department at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. Arrangements are made for him to be transferred stat to the tertiary hospital while he is still stable. It is described as a ripping sensation that radiates to his back.

Emergency Department 122

Emergency Department Stroke Operations Hospitals 122

EM Literature of Note

SEPTEMBER 12, 2021

A couple months back, this little report – MaRISS – was published with minimal fanfare in Stroke. The stated purpose of this study: “The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population.” rate of sICH.

Stroke 40

Stroke Outcomes Hospitals 40

RebelEM

SEPTEMBER 28, 2023

In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact. In these cases, thrombolysis is recommended to improve morbidity and mortality. Primary PCI: 95.7%

EKG/ECG 135

EKG/ECG Allergic Reactions Shock Stroke 135

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. hours increased the NNT for a good outcome to 20. The expanded window of 3-4.5

Stroke 93

Stroke Outcomes EKG/ECG Research 93

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

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? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

Sensible Medicine

DECEMBER 4, 2023

In these patients, scientists continue to study ways to improve outcomes. Swedish and UK researchers had the idea that the drug dapagliflozin might improve outcomes in patients who have an MI big enough to cause mild heart damage. So… the question was: does dapagliflozin—in addition to standard care—improve outcomes.

Outcomes 101

Outcomes Research Hospitals Stroke 101

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 90

Stroke EKG/ECG Seizures CPR 90

Sensible Medicine

OCTOBER 23, 2023

An example is the hospital readmissions reduction program (HRRP), which penalized hospitals for excess readmissions. The authors chose two primary outcomes: one a MACE endpoint with MI, stroke, and TIA. The Results: The first primary endpoint (MI, stroke, TIA) occurred at a rate of 14.8 per 1000 patient-years.

Stroke 79

Stroke Outcomes Hospitals 79

The Skeptics' Guide to EM

MARCH 6, 2019

Shahriar Zehtabchi is a tenured professor and Vice Chair of Academic Affairs in the Department of Emergency Medicine at SUNY Downstate Medical Center & Kings County Hospital. Shahriar also serves […] The post SGEM Xtra: Walk of Life – Thrombolysis for Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 40

Stroke Academics Hospitals Outcomes 40

EMDocs

AUGUST 13, 2024

If the patient has asymptomatic elevated BP, the optimal management strategy is not clear, and there are no data that treating asymptomatic elevated BP (marked versus not) in the acute care setting improves clinical outcomes. Administration of IV antihypertensives in the absence of HTN emergency is not recommended.

Stroke 95

Stroke Administration Outcomes Hospitals 95

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

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). This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 95

Sepsis Shock Resuscitation Outcomes 95

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. The hypothesis tested in INTERACT-4 is whether antihypertensive treatment might be started even earlier, in the pre-hospital setting, reducing any time-dependent negative effects.

Research 49

Research Stroke Outcomes Sepsis 49

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Outcomes Research 98

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

The Skeptics' Guide to EM

JUNE 5, 2021

He also works at an urgent care and a rural critical access hospital. He also works at an urgent care and a rural critical access hospital. Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial.

Urgent Care 52

Urgent Care Stroke Critical Access Outcomes 52

Taming the SRU

APRIL 17, 2024

The primary outcome was defined as agreement of less than 10 % of the mean arterial pressure (MAP) between simultaneously recorded IABP and NIBP measurements. 1) Data comparing the accuracy between IABP and NIBP measurements are limited. 53286 measurement pairs were recorded with a median of 13 measurements per patient.

Sepsis 93

Sepsis Research Stroke Academics 93

AED Leader

DECEMBER 6, 2024

This article explores Stryker’s impactful role in revolutionizing cardiac emergency preparedness worldwide, from pioneering technologies and addressing healthcare disparities to aligning with major organizations like the American Heart Association in pursuit of improved outcomes.

Basic Life Support 52

Basic Life Support Resuscitation Outcomes Hospitals 52

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.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

The Skeptics' Guide to EM

APRIL 8, 2023

The objective of that study was the following: * To investigate how the’ natural experiment’ of reconfiguring the emergency healthcare system in Denmark affected in-hospital and 30-day mortality on a national level. They found no statistical difference for in-hospital mortality but slightly increased 30-day mortality.

Stroke 55

Stroke Emergency Department COPD Academics 55

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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). A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Sensible Medicine

APRIL 16, 2024

The only problem is that all these people were smokers, and they were not being followed for major adverse cardiovascular events (cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for unstable angina -- MACE) which is what we use ASCVD to predict.

Radiology 97

Radiology Radiology Stroke Hospitals 97

PulmCCM

MAY 8, 2023

Among 1150 patients considered high risk for aspiration at 15 French hospitals, those randomized to receive remifentanil had a higher rate of severe complications of intubation (aspiration, hypoxemia, hypotension, arrhythmia, cardiac arrest, or anaphylaxis), compared to those receiving neuromuscular blockade.

Stroke 52

Stroke Blood Transfusions Hospice Anaphylaxis 52