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. ” However, that was in the era before mechanical thrombectomy. Along with endovascular thr… Read more

Stroke 52

Stroke Outcomes Hospitals 52

Sensible Medicine

JUNE 16, 2024

The other unbelievable thing about TAVR is that strokes are less common than you’d think. Early studies show that the device catches debris that would have occluded blood vessels in the brain—iow, caused stroke. lower rate of stroke in the treatment arm. The verbs squishing or smooshing come to mind.

Stroke 73

Stroke Shock Wellness Outcomes 73

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 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

PulmCCM

APRIL 19, 2024

There were lingering hopes that for patients with ischemic stroke, adding parenteral anticoagulation after thrombolytic therapy might improve outcomes.

Stroke 52

Stroke Outcomes 52

PulmCCM

AUGUST 24, 2024

Thrombolysis with alteplase (tPA) or tenecteplase (TNK) has become standard care for moderate-to-severe ischemic strokes presenting within 4.5 Patients with the mildest strokes were excluded from the trials that established the bene… Read more

Stroke 40

Stroke Outcomes 40

The Skeptics' Guide to EM

OCTOBER 5, 2019

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. While preparing for transport you contemplate administering nitroglycerin due to the likelihood of stroke. The Lancet March 2019. The Lancet March 2019.

Stroke 52

Stroke Hospitals EMS Administration 52

EMDocs

AUGUST 17, 2024

. #1: TNK Up to 24 Hours for Stroke? Source Tenecteplase for Ischemic Stroke at 4.5 Spoon Feed In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months.

Stroke 95

Stroke Administration Outcomes 95

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. 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

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. doi: 10.1161/STR.0000000000000407.

Stroke 98

Stroke Outcomes Hospitals 98

Emergency Medicine Cases

JULY 4, 2017

In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke. The post Journal Jam 10 Part 2 Endovascular Therapy for Stroke appeared first on Emergency Medicine Cases.

Stroke 52

Stroke EMS Outcomes 52

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

EMDocs

MARCH 19, 2024

Thromboembolism can lead to stroke (and this is a more common cause of stroke in the setting of sCAD than hypoperfusion). Epidemiology Common cause of strokes in young people; sCAD accounts for 15-24% of strokes in patients < 45 years. Rare cause of stroke overall – incidence is 1.72

Stroke 105

Stroke EMS Administration Ultrasounds 105

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

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. He undergoes a thrombectomy, but his outcome is poor. Plaintiff : The family’s concern is that a delay in appropriate treatment led to his poor outcome.

Documentation/Coding 104

Documentation/Coding Stroke Outcomes EMS 104

The Skeptics' Guide to EM

MAY 15, 2021

Daniel Schwerin is employed with Prisma Health-Upstate as a clinical assistant professor, emergency medicine GME director for emergency medical services and medical director for several local EMS agencies and has lectured on prehospital stroke management. Background: We have discussed stroke so many times on the SGEM.

Stroke 52

Stroke EMS Outcomes 52

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. Strokes and heart failure are the main complications of AF. And even when drugs suppress AF, trials failed to show that doing so reduces stroke or heart failure. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly.

Stroke 100

Stroke Outcomes Shock Research 100

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

EMDocs

MAY 4, 2024

. #2: The Endovascular Therapy Train Continues Onward Spoon Feed This was an exploratory analysis of the recently published SELECT2 trial, which randomized 352 adults with acute ischemic stroke due to carotid or M1 MCA occlusion to endovascular thrombectomy (EVT) or medical management.

Documentation/Coding 98

Documentation/Coding Stroke Emergency Department Pediatrics 98

Sensible Medicine

MAY 6, 2024

A treatment to reduce stroke is tested in a clinical trial. of patients had a stroke vs 2.9% In the PROTECTED TAVR trial, the confidence intervals went from -1.7% (a lower stroke rate) to 0.5% (a higher rate of stroke). In the treatment group, 2.3% in the control arm. difference is signal or noise. Emphasis mine.)

Stroke 106

Stroke Shock Outcomes 106

The Skeptics' Guide to EM

MAY 1, 2021

Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the […] The post SGEM Xtra: The NNT is Mellow Yellow for tPA in Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. improvement in good neurologic outcome, a 5.4% Emerg Med Australas 2016.

Stroke 52

Stroke Outcomes Wellness 52

EMDocs

SEPTEMBER 2, 2023

. #1: Dual Antiplatelets or Lytics for Minor Stroke? Spoon Feed In minor acute ischemic stroke (AIS) patients presenting within 4.5 hours of onset, dual antiplatelet therapy (DAPT) is non-inferior to intravenous alteplase for excellent neurologic outcome at 90 days.

Stroke 95

Stroke Pediatrics Outcomes 95

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

The Skeptics' Guide to EM

FEBRUARY 26, 2019

This has been through various peer reviewed publications, doing Emergency Medicine Abstracts (EMA) audio program […] The post SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. It appears his concerns may have come true. Six trials showed no benefit.

Stroke 52

Stroke EMS Research Outcomes 52

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

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.

Stroke 88

Stroke Administration Outcomes 88

Sensible Medicine

NOVEMBER 28, 2023

The primary outcome was stroke or systemic embolism and the primary safety outcome was major bleeding. The mean age was about 77 years old and the patients were at high risk of stroke from atrial fibrillation with a mean CHA 2 DS 2 -VASc score of nearly 4. Patients were then randomly assigned to apixaban or 81 mg of ASA.

Stroke 97

Stroke Academics Outcomes Administration 97

EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Epub 2023 Jun 9. #3:

Stroke 86

Stroke Shock Pediatrics Resuscitation 86

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

Taming the SRU

JULY 2, 2024

The primary outcome was 30-day mortality, with secondary outcomes of 24-hour mortality and vascular occlusive events such as DVT, PE, MI, or stroke. TXA dosing was standardized in all trials to a 1g bolus over 10 minutes followed by a 1g infusion over 8 hours. and a NNT of 61.

Stroke 94

Stroke Outcomes 94

EM Literature of Note

MARCH 9, 2021

” This “current literature” of which they speak is primarily a citation from last year’s Stroke , a single-center cohort study and updated patient-level meta-analysis. Does the eye work like that? In the “cohort” portion, this site treated 16 patients with CRAO with alteplase within 4.5

Stroke 40

Stroke Outcomes Wellness 40

PulmCCM

SEPTEMBER 17, 2023

The Centers for Disease Control and Prevention formally called on hospitals to develop robust sepsis care programs to systematically identify and treat sepsis, track outcomes, and improve care delivery. Unlike strokes and STEMIs, sepsis has no gold standard for diagnosis. ” What is that, a sepsis Stasi?

CDC 98

CDC Sepsis Hospitals Documentation/Coding 98

Sensible Medicine

JUNE 28, 2024

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. And then, I guess because cancer-related hypercoagulability could conceivably cause a stroke, they went further. I love my job.

Stroke 105

Stroke Academics Hospitals EKG/ECG 105

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. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Sensible Medicine

FEBRUARY 13, 2024

In brief, the trial compared apixaban vs aspirin in patients who had had a stroke of unknown source and evidence of atrial cardiopathy. Recurrent stroke (the primary endpoint) occurred in 40 patients in each group. Apixaban did not reduce the rate of recurrent stroke over aspirin in these patients. The hazard ratio was 1.00.

Stroke 75

Stroke Outcomes Wellness EKG/ECG 75

Sensible Medicine

JULY 15, 2024

Randomized clinical trials have demonstrated that GLP1a reduce cardiac outcomes in patients with diabetes and most recently in patients with obesity and established cardiac disease. No patient checks in to their clinic or the ER to announce that they have not had a stroke because of the drug. Because neurosurgeons see brain bleeds.

Stroke 123

Stroke Research Outcomes 123

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) Trends in the Management and Outcomes of Acute Pulmonary Embolism Analysis from the RIETE Registry. Ann Emerg Med. 2024;84(5):518-529.

Hospitals 52

Hospitals Administration Outcomes Stroke 52