ACEP Now

JULY 7, 2023

One operator should perform defibrillation in the anterolateral position, followed by another operator providing a second shock in the anteroposterior position after a delay of less than one second. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. References Tsao CW, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Taming the SRU

JULY 24, 2024

Population Patients were adult (18 or older) patients at a single academic emergency department who were triaged to a resuscitation bay and were not classified as a trauma, STEMI, stroke, cardiac arrest, or active labor. The gold standard comparison was a final discharge diagnosis of sepsis that was marked as present at time of admission.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Mind The Bleep

FEBRUARY 5, 2024

The optic nerve (CN II), which is covered by the meninges and is supplied by the ophthalmic artery (functionally operating as an extension of the forebrain), exits the eye and enters the middle cranial fossa through the optic canal in the lesser wing of the sphenoid bone. Bibliography Gupta, M. and Bordoni, B. Neuroanatomy, Visual Pathway.

Stroke 52

Stroke Operations 52

PulmCCM

JANUARY 6, 2025

there is no validated method to diagnose sepsis; i.e., that unlike in diabetes, strokes, and bypass surgery, there is no way to reliably quantify the denominator in the SEP-1 quality metric). Instead of clinical micromanagement, in its new form it would incentivize continuous improvement in systemwide operational processes.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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 Research Outcomes 98

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

Ziqitza HealthCare Ltd

AUGUST 22, 2024

Hypertension can completely wear out the arteries gradually as time goes on and lead to severe illnesses like heart disease, stroke, kidney disease etc. ACE inhibitors: They operate by obstructing the development of a chemical called angiotensin that will constrict vessels thus making them relax and reduce the level of tension on them.

Ambulance Services 52

Ambulance Services Stroke Operations Wellness 52

Northwestern EM Blog

JUNE 16, 2024

The most common symptoms include: Lightheadedness Syncope Chest pain Exercise intolerance Fatigue **Important note: The heart rate at which patients experience symptoms may vary based on their ability to increase stroke volume. Operational definition of normal sinus heart rate. Bishop, R. L., & Rifkin, R. link] UpToDate.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Taming the SRU

JULY 31, 2024

Barometric pressure, humidity, and temperature changes may influence stroke and fall incidence (especially in elderly patients with cardiovascular risk factors). Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

EMDocs

OCTOBER 30, 2023

Under standard operating protocols, residual contrast materials are usually wasted, according to current CDC and JC standards. CT scans have become an integral part of the ED diagnostic process, serving as a diagnostic tool to aid in determining appropriate disposition, risk assessment, and guiding admission decisions.

Radiology 101

Radiology Radiology Emergency Department Hospitals 101

Dr. Smith's ECG Blog

MARCH 19, 2019

Think of : i ) Drugs ( many drugs prolong the QT interval — and combinations of drugs may result in marked prolongation ) ; ii ) “ Lytes ” ( ie, Think of low K+ — low Mg++ — and / or — low Ca++ ) ; and , iii ) a CNS Catastrophe ( ie, stroke, bleed, coma, seizure, trauma, brain tumor ).

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

Dr. Smith's ECG Blog

MAY 5, 2023

Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity.

EKG/ECG 52

EKG/ECG Stroke Operations 52

Taming the SRU

AUGUST 4, 2024

The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room. Operative technique for trachea-innominate artery fistula repair. J Vasc Surg.

Operations 52

Operations Pediatrics Radiology Radiology 52

ACEP Now

JULY 7, 2024

For example, other modes of EEG monitoring may be used in the operative setting, including bispectral index monitoring (BIS) and SEDline device, to monitor depth of sedation. Some institutions have the capability to perform real-time EEG monitoring and interpretation by a neurologist in the ED.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Often more than one entity is operative as is likely in this case. That said, the fact that the rate was slightly faster in the Baseline ECG (ie, ECG #2 ) means that this factor was not operative in this case. Clinical correlation helps to sort this out. As per Dr. Smith the QTc was clearly prolonged in ECG #1.

EKG/ECG 52

EKG/ECG Operations Seizures Stroke 52

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

Taming the SRU

AUGUST 30, 2023

This finding was not significantly different among operators with different levels of experience, or between adults and children. The authors recommended against the use of biomarkers or clinical symptoms stand-alone tests to diagnose bacterial pneumonia given the poor test characteristics.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EMDocs

AUGUST 10, 2023

Inclusion criteria: Enrolled patients over the age of 18 with acute ischemic stroke with CTA confirmed occlusion of ICA, or M1 or M2 segment of MCA Within 4.5 hours of stroke onset. My take: It’s entirely possible that in comprehensive stroke centers tPA may confer no added benefit to thrombectomy for anterior circulation LVOs.

Stroke 95

Stroke Outcomes Operations Hospitals 95

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks?

Stroke 98

Stroke Fractures Operations Outcomes 98

The Skeptics' Guide to EM

MARCH 2, 2024

Symptoms may include more severe chest pain radiating to the back, loss of consciousness, or symptoms of stroke if the blood supply to the brain is affected. Type A AoDs generally require an emergent trip to the operating room as soon as they are identified to reduce the likelihood of a terrible outcome.

Emergency Department 132

Emergency Department Stroke Operations Hospitals 132

ACEP Now

JANUARY 5, 2025

In a prospective study comparing clinician gestalt against systemic inflammatory response syndrome, Sequential Organ Failure Assessment (SOFA), quick SOFA, Modified Early Warning Score (MEWS), and a logistic regression machine learning model using Least Absolute Shrinkage and Selection Operator (LASSO), the obvious winner was the clinician.

Sepsis 40

Sepsis Research Airway Management Stroke 40

Sensible Medicine

JUNE 17, 2024

Stroke occurred in 7 patients (0.12%). Notable also that in the main paper, there was one TIA in the PFA arm and one stroke in the thermal arm but neither of these were in the MRI subgroup of the study. What’s more, the lack of esophageal damage has encouraged PFA operators to deliver more (not less) ablation.

Shock 126

Shock Stroke Operations Ultrasounds 126

ACEP Now

MARCH 6, 2024

What’s New in Stroke Care? The simplicity of tenecteplase administration makes its use likely the preferred agent for treating acute ischemic stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke.

Research 52

Research Airway Management Stroke Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

since what appears to be a major causative factor ( simultaneous ingestion of 9 herbal preparations ) is no longer operative. Nossen — results of genetic testing for LQTS are pending. Perhaps this patient may not need ICD placement? Further evaluation should help provide an answer.

Seizures 112

Seizures EKG/ECG EMS Stroke 112

PulmCCM

DECEMBER 12, 2024

However, embolized patients had nominally higher rates of death at 90 days (5% vs ~3%), functional deterioration (~12% vs ~10%), and disabling stroke (2 patients), leading authors to suggest caution while awaiting further safety data on the procedure. that were not associated with any research study) between 2017 and 2023, according to CMS.

Stroke 52

Stroke Operations Research 52

RebelEM

JUNE 19, 2023

SBP < 75 mm Hg: 39% SBP 76-89 mm Hg: 33% Critical Findings: No statistically significant difference in safety outcomes (DVT, PE, MI, Stroke) TXA Placebo RR (95% CI) Primary Outcome Good Functional Outcome (6 months) 53.7% Majority of patients (92%) had blunt trauma. 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7%

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. 1 Opioids or anxiolytics are often given to patients whose diagnosis of AD is missed or delayed.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Ziqitza HealthCare Ltd

JULY 14, 2023

Often, the blood vessels of such patients become narrow or blocked, leading to chest pain, heart attacks, or strokes, eventually resulting in death. These diseases affect the patient’s circulatory system, blood vessels, heart muscle, valves, or rhythm.

Ambulance Services 52

Ambulance Services Basic Life Support Operations Stroke 52

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” He endorses nausea without vomiting and denies fever. In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. J Urol 2019.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. 1 The Rise of the Miami BBL An entire industry has emerged around gluteal AFTs in Miami.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

ACEP Now

SEPTEMBER 13, 2023

Dr. Prescott says while significant changes have been made since the time of the report, including improved communications in the pre-hospital world, stroke care and trauma care, it’s time to take another good look at Emergency Medicine. It’s time for another push.”

EMS 45

EMS Research Academics Military 45

Pediatric Emergency Playbook

JUNE 1, 2017

The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI. Fontan Operation and the Single Ventricle. However, the presence of PFO alone does not connote higher risk. Congenit Heart Dis. 2007; 2:2-11.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

AUGUST 1, 2018

First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. Make sure that the patient knows not to operate vehicles or heavy machinery under the influence of drugs. times higher risk of stroke or TIA. Cannabis users who smoked at least once weekly had a 3.3

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Don't Forget the Bubbles

FEBRUARY 7, 2024

. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Urgent senior review, decision making and operation 31.3%

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

ACEP Now

DECEMBER 7, 2024

The use of thrombolytics for acute ischemic stroke may be one of the most controversial topics in emergency medicine during the last several decades. 1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. This debate recurs in multiple forums including many previous pieces in ACEP Now.

Stroke 98

Stroke Research Hospitals Outcomes 98

EMDocs

NOVEMBER 4, 2024

80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. Pain can be triggered spontaneously and noxious/innocuous stimuli are pathologically amplified.

Emergency Department 106

Emergency Department Fractures Burns EMS 106