PulmCCM

OCTOBER 30, 2024

A majority of patients with significant strokes experience fever within the first week after their vascular injury. The presence, intensity, and persistence of fevers are associated with worse outcomes after strokes of any type. Stroke guidelines advise treating and preventing fever, but only based on observational evidence.

Stroke 52

Stroke Outcomes 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 77

Stroke Shock Wellness Outcomes 77

Sensible Medicine

NOVEMBER 6, 2023

Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. This study report included only 45-day outcomes. This is a decidedly bad outcome. Pause there.

Stroke 132

Stroke Outcomes Ultrasounds Wellness 132

Sensible Medicine

SEPTEMBER 2, 2024

Semaglutide led to a 20% reduction in a composite primary endpoint of CV death, myocardial infarction or stroke. Next point: look at the number of primary outcome events. Third point: the authors knew that people would be interested in other outcomes besides the composite of CVD, MI and stroke. The hazard ratio was 0.80

Stroke 118

Stroke Outcomes 118

EM Ottawa

MAY 20, 2024

Question and Methods: RCT at 103 sites to compare outcomes at 30 days for early versus late DOAC initiation among patients with ischemic stroke and atrial fibrillation.

Stroke 56

Stroke Outcomes 56

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

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 133

Seizures Stroke Outcomes Research 133

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 1.40) No statistically significant difference in secondary outcomes No significant difference in safety outcomes Death 18% vs. 19%, RR 0.94 (0.68-1.30) N Engl J Med.

Stroke 67

Stroke Outcomes Operations Hospitals 67

PulmCCM

OCTOBER 23, 2024

Endovascular thrombectomy became standard care for ischemic strokes resulting from large vessel occlusion (LVO) in the anterior cerebral circulation after randomized trials published in the mid-2010s showed improved outcomes with the intervention. However, these modalities aren’t as widely available as noncontrast CT. Read more

Stroke 52

Stroke Outcomes 52

Sensible Medicine

NOVEMBER 20, 2023

That means reducing events caused by clots—like stroke. The OCEANIC AF trial enrolled patients with AF who had stroke risk factors. The primary outcome was stroke or systemic embolism. But, ultimately, a new medical intervention has to improve an important outcome as well as or better than standard care.

Stroke 110

Stroke Outcomes Wellness 110

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 136

Stroke Outcomes Hospitals Administration 136

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

Sensible Medicine

OCTOBER 2, 2023

The general concept is how trials measure, report and interpret outcomes. Before any experiment, choices have to be made about which outcome(s) to measure. People will argue about the choices, but a steadfast rule should be that reporting outcomes should be consistent over time. More on the specifics in a moment. The HR was 1.3

Stroke 106

Stroke Outcomes Wellness 106

EM Literature of Note

DECEMBER 4, 2024

This most recent publication looks at “e-Triggers” – effectively, combinations of both patient features and patient outcomes meant to retrospectively identify cohorts in which substantial numbers of patients can be found to have MODs. The bad news is primarily patient-centered. Thus, the harm has already reached the patient.

Emergency Department 92

Emergency Department Stroke Patient Safety Research 92

PulmCCM

MAY 12, 2024

Endovascular thrombectomy became standard care for ischemic strokes resulting from large vessel occlusion (LVO) in the anterior cerebral circulation after randomized trials published in the mid-2010s showed improved outcomes with the intervention. The LASTE Trial: Thrombectomy f… Read more

Stroke 52

Stroke Outcomes 52

American Medical Compliance

APRIL 17, 2024

The following Effective Management of Dysphagia in Stroke Patients Training educates healthcare providers (HCP) on the structures involved in swallowing. million stroke survivors in the US. Aspiration pneumonia is the most common consequence of dysphagia following a stroke.

Stroke 52

Stroke Dehydration Outcomes 52

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 Outcomes 52

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

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

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. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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

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 93

Stroke EMS Administration Ultrasounds 93

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 136

Shock Outcomes Resuscitation Stroke 136

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

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 109

Stroke Outcomes Hospitals Wellness 109

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 73

Stroke Outcomes EMS Seizures 73

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 97

Stroke Fractures Outcomes Operations 97

Sensible Medicine

JUNE 5, 2023

Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.

Stroke 91

Stroke Outcomes Hyperthermia / Hypothermia Shock 91

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 125

CDC Outcomes Radiology Radiology 125

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

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

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 81

Stroke Outcomes Hospitals 81

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? About two thirds of patients in each arm were vaccinated.

COPD 95

COPD Stroke Academics Urgent Care 95

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 79

Stroke Outcomes Wellness EKG/ECG 79

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

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 80

Documentation/Coding Stroke Outcomes EMS 80