PulmCCM

MAY 27, 2024

Uncontrolled hypertension is a major risk factor for both ischemic and hemorrhagic strokes. Maintaining blood pressure at or near the normal range (again, over long periods) reduces the risk of stroke. Once an acute stroke is underway, however, the calculus changes.

Stroke 52

Stroke Hospitals 52

Sensible Medicine

FEBRUARY 12, 2024

Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Stroke came when these clots moved northward to the brain. One of the big issues with this theory was that studies had failed to show a strong relationship in time between the stroke and the irregular rhythm.

Wellness 133

Wellness Stroke EKG/ECG Academics 133

PulmCCM

MAY 3, 2024

While outcomes from acute ischemic stroke due to large vessel occlusion in the anterior circulation have improved substantially in the era of thrombolytics and mechanical thrombectomy, overall outcomes remain poor. Studies in animal models have suggested corticosteroids might reduce infarct size or extension of subsequent cerebral edema.

Stroke 52

Stroke Outcomes Hospitals 52

ACEP Now

MAY 9, 2024

The clinical policy on the management of adult patients presenting to the emergency department (ED) with acute ischemic stroke, was approved by the ACEP Board of Directors in April 2023. Approximately 800,000 people in the United States are diagnosed with a stroke each year at an estimated cost of approximately 46 billion dollars.

Stroke 52

Stroke Wellness Emergency Department Hospitals 52

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. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. I love my job.

Stroke 105

Stroke Academics EKG/ECG Hospitals 105

Medical Law

NOVEMBER 2, 2021

Cottage Rehabilitation Hospital (CRH) was one of four local organizations honored during the 16 th annual Santa Barbara Mayor’s Award ceremony by Mayor Cathy Murillo on Thursday, October 28, 2021. Medical Director Dr. Sharon Basham and Ari Dejong , Vice President of Goleta Valley Cottage Hospital, accepted the award on behalf of CRH.

Hospitals 52

Hospitals Stroke 52

ACEP Now

MARCH 11, 2025

2-4 A study in Annals of Emergency Medicine of almost 300,000 patients hospitalized with acute PE between 2011-2020 found that the use of UFH increased from 41.9 no increase in vasopressor use, mechanical ventilation, admission to an intensive care unit, in-hospital mortality). Stubblefield WB, Helderman R, Strokes N, et al.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

Emergency Medicine Journal

SEPTEMBER 25, 2024

Ambulance crew’s main focus during stroke care is symptom recognition and rapid transport to specialist units to maximise access to and effectiveness of time-critical treatments. 2 3 Increased OSTs contribute to deteriorating symptom onset to arrival at hospital times, which represents worse care for patients.

Stroke 52

Stroke Ambulance Services Hospitals 52

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

Emergency Medicine Journal

SEPTEMBER 25, 2024

Severe disability due to large vessel occlusion (LVO) stroke can be avoided by emergency mechanical thrombectomy (MT) 1 but provision varies nationally and internationally according to the availability of specialist facilities.

Stroke 52

Stroke Hospitals 52

EMDocs

SEPTEMBER 8, 2024

Study inclusion criteria: RCT or nonrandomized comparative observational studies Neurologic emergencies defined as: Hypertensive encephalopathy Ischemic stroke Hemorrhagic stroke Subarachnoid hemorrhage TBI Anti-hypertensive agents included nicardipine, clevidipine, labetalol, and nitroprusside. clevidipine). doi: 10.1161/STR.0000000000000407.

Stroke 100

Stroke Outcomes Hospitals 100

Emergency Medicine Journal

MARCH 21, 2024

Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).

Stroke 52

Stroke Documentation/Coding EMS Hospitals 52

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 123

Stroke Outcomes Hospitals Wellness 123

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable.

Stroke 98

Stroke Fractures 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 93

EMS Stroke Outcomes Hospitals 93

PulmCCM

DECEMBER 11, 2023

Vitamin C did not improve outcomes among patients hospitalized with Covid-19. LOVIT-COVID and REMAP-CAP ) Twice-daily oral zinc reduced mortality, ICU admission rate, and hospital length of stay in patients with Covid-19 in Tunisia in 2022. It’s the first treatment to appear to do so.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

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 99

Documentation/Coding Stroke Outcomes EMS 99

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 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 133

Stroke Outcomes Hospitals Administration 133

ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. Bilateral symptoms are more frequent in posterior circulation strokes and can be deceptive.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

RebelEM

AUGUST 22, 2024

Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. What They Did: Retrospective review of consecutive RAO cases managed as part of a remote ophthalmology consult protocol activated on May 1, 2021, at three stroke centers across a health system.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

EM Literature of Note

SEPTEMBER 12, 2021

A couple months back, this little report – MaRISS – was published with minimal fanfare in Stroke. To be included in MaRISS, patients with mild stroke were approached after initial treatment, within 24 hours of hospital admission. How many patients with mild stroke were admitted to participating hospitals during the study period?

Stroke 40

Stroke Outcomes Hospitals 40

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. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. References Tsao CW, et al. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

JournalFeed

APRIL 4, 2020

We cover Pediatric Surviving Sepsis; mortality risk after out-of-hospital naloxone; spontaneous pneumothorax - tube or no tube; opioids prior to pediatric sedation; and HINTS by emergency physicians and stroke risk. Here is the JournalFeed Podcast for the week of March 30- April 3, 2020.

Sepsis 52

Sepsis Stroke Pediatrics Hospitals 52

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 91

Stroke Outcomes EMS Seizures 91

Sensible Medicine

DECEMBER 28, 2023

The idea is to prevent stroke and reduce bleeding by plugging the appendage. But, get this: PREVAIL did not find noninferiority in its first co-primary endpoint of stroke, systemic embolism or cardiovascular death. I will use his list, expanding on each of his short statements.

Stroke 141

Stroke Ultrasounds Outcomes Hospitals 141

ACEP Now

JANUARY 5, 2025

One of the paradoxical oddities of treatment for acute stroke is the reversal of anticoagulation to enable treatment with thrombolysis. Use of Bones Although the topic hardly rises to the level of serious controversy, the best protocol for vascular access in the context of out-of-hospital cardiac arrest is an ongoing unanswered question.

Sepsis 40

Sepsis Research Airway Management Stroke 40

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 131

Emergency Department Stroke Operations Hospitals 131

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 137

EKG/ECG Allergic Reactions Shock Stroke 137

Emergency Medicine Journal

JUNE 20, 2024

Background Mechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. Participants perceived suspected stroke as a complex scenario.

Stroke 40

Stroke Hospitals 40

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

Mind The Bleep

FEBRUARY 2, 2025

For example: “If ultrasound negative then reassure and discharge”, “If CRP normal then safety net and advise to see GP if symptoms recur” Treatment Escalation Plan/ DNACPR Clearly document if the patient has an existing DNACPR in place- they may come to hospital with a copy.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C., 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 111

CDC Radiology Radiology Head Injuries 111

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. Hospital policy is essential for DOAC reversal in the setting of a bleed.

Stroke 94

Stroke Outcomes Hospitals 94

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. The expanded window of 3-4.5 hours increased the NNT for a good outcome to 20.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

EMDocs

JUNE 28, 2023

He is transported to a different hospital as possible trauma. A lawsuit is filed against the first hospital and ED physician. ” He could then have been treated for his stroke and not have to be in a nursing home for the rest of his life. Result: The hospital agreed to a seven-figure settlement during mediation.

Documentation/Coding 87

Documentation/Coding EMS Stroke Patient Safety 87

EMDocs

AUGUST 13, 2024

Of note, they caution against lowering the BP of patients with asymptomatic markedly elevated BP prior to going to the hospital floor, as this is not evidence based and furthers the myth that treatment of the BP is necessary. The AHA Scientific Statement recommends the A-I-M approach (Assess, Identify, Modify) for HTN.

Stroke 98

Stroke Administration Outcomes Hospitals 98