EM@3AM: Brainstem Strokes
EMDocs
MAY 11, 2024
Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?
Outcomes Stroke Ultrasounds 
Non-significant Studies Can Teach A Lot
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.
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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?
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).
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A Comprehensive Guide to Surgical Clerking
Mind The Bleep
FEBRUARY 2, 2025
Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Document main findings from any imaging including if normal Differential Diagnoses You can use the surgical sieve approach to identify appropriate differential diagnoses.
emDOCs Podcast – Episode 97: Spontaneous Cervical Artery Dissection
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
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Is the FDA too lax?
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. One makes an ultrasound device, the other a radiofrequency device. This was a recent FDA approval.
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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?
RebelEM
JUNE 26, 2023
Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5
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Friday Reflection 41: Sometimes I Just Need to Complain
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.
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Grand Rounds Recap 8.2.23
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
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Putting Clinical Gestalt to Work in the Emergency Department
ACEP Now
OCTOBER 29, 2024
4 However, emergency physicians rely on gestalt to predict outcomes well. The externally validated Canadian Syncope Risk Score (CSRS) demonstrated no better prediction of 30-day adverse outcomes for “very low” and “low” risk patients than clinical judgment alone of emergency physicians. Urology took him for orchiopexy.
Rethinking the Role of TXA: Are We Asking Too Much?
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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.
Serratus Anterior Plane Blocks for Rib Fractures in the ED
Taming the SRU
NOVEMBER 3, 2023
Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The primary outcome in this study was a change in pain score at rest 60 minutes after block. 41, 2695–2701 (2022).
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SAEM Clinical Images Series: Retrobulbar Spot Sign
ALiEM
JANUARY 29, 2024
It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol.
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Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia
Dr. Smith's ECG Blog
APRIL 2, 2024
Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 The patient awoke and had a good outcome!
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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1
EMDocs
MAY 15, 2024
Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present.
REBEL Core Cast 97.0 – Acute Vision Loss II
RebelEM
MARCH 8, 2023
Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. 790-819 Core Ultrasound: Vitreous vs Retinal Detachmen t Post Created By: Anand Swaminathan MD, MPH Post Peer Reviewed By: Salim R.
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Grand Rounds Recap 2.14.24
Taming the SRU
FEBRUARY 24, 2024
Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.
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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2
EMDocs
MAY 28, 2024
Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present. pneumoniae, C.
The Latest in Critical Care, 7/10/23 (Issue #8)
PulmCCM
JULY 10, 2023
At 28 days, there were no observed differences in the primary outcome (an odd composite of mortality and emergence of antibiotic resistance), and no difference in survival at 90 days. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding. access, etc., detailed here.
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Treatment of Left Main Disease
Resus Review
OCTOBER 9, 2015
However, advancements in percutaneous coronary intervention (such as drug-eluting stents and techniques, risk stratification, and intravascular ultrasound) have increased the viability of this treatment option. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients.
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Nephrolithiasis: Ultrasonography versus Computed Tomography
Northwestern EM Blog
MAY 16, 2022
What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?
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Grand Rounds Recap 5.22.24
Taming the SRU
JUNE 3, 2024
Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. Benefits of transport are evidenced based.
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Paravalvular Regurgitation after TAVI
Resus Review
OCTOBER 28, 2015
With hemodynamically significant regurgitation, a postdilation can often significantly reduce paravalvular regurgitation without increased risk of stroke or permanent pacemaker placement. 5-year outcome after transcatheter aortic valve implantation. The cross-sectional area of the regurgitation typically decreases about 45% (0.36
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Brazilian Butt Lift Procedure Can Result in Emergency Department Visits
ACEP Now
MAY 9, 2024
These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported. References Garcia SE. Butt Lifts Are Booming.
The Higher Tech Kid in the ED
Pediatric Emergency Playbook
OCTOBER 1, 2017
Also used for severe MS, stroke, TBI, chronic pain. Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Are VNS safe in everyday life? Pediatr Neurosurg. 2013; 49:138–144. Childs Nerv Syst.
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Journal Club - Tranexamic Acid in Trauma
Downeast Emergency Medicine
APRIL 26, 2021
4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke).
Top 10 Things I Learned at #ALLOhioEM19
All Ohio EM
FEBRUARY 11, 2019
Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. The MR CLEAN trial showed improved functional outcome if endovascular therapy was initiated within 6 hrs. Third, POCUS (point-of-care ultrasound) is your friend. NNT 7, NNH 19.
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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
Stroke-volume:50 ml. The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. Left ventricular end-diastolic volume: 99 ml.
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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?
Dr. Smith's ECG Blog
MAY 30, 2023
Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. 1 mg of Atropine was given and the heart rate increased transiently to 60. RVMI explains part of the shock. STE and STD were measured at the J-point, relative to the PQ junction.
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Episode 31 - Emergency Department Management of Patients Taking Direct Oral Anticoagulant Agents (Pharmacology CME)
EB Medicine
AUGUST 6, 2019
Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.
A Comprehensive Guide to Surgical Clerking
Mind The Bleep
NOVEMBER 21, 2023
Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Document main findings from any imaging including if normal Differential Diagnoses You can use the surgical sieve approach to identify appropriate differential diagnoses.
Grand Rounds Recap 4.19.23
Taming the SRU
MAY 1, 2023
Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.
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Diagnostics: Inflammatory Markers
Taming the SRU
AUGUST 30, 2023
Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45].
Episode 19 - Cannabinoids: Emerging Evidence in Use and Abuse
EB Medicine
AUGUST 1, 2018
It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA.
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Episode 20 - Emergency Department Management of North American Snake Envenomations
EB Medicine
SEPTEMBER 1, 2018
Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.
Testicular torsion
Don't Forget the Bubbles
FEBRUARY 7, 2024
This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. What is the role of ultrasound?
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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.
Dr. Smith's ECG Blog
APRIL 8, 2015
Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1.
Episode 25 - Evaluation and Management of Life-Threatening Headaches in the Emergency Department
EB Medicine
FEBRUARY 1, 2019
Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. For a visual reference, see Table 3 in the print issue.
CT Angiography Head and Neck: Indications and Limitations
EMDocs
NOVEMBER 13, 2023
2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% 8 The data in Mayer et al.
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Pain Management of Common Chief Complaints in the ED
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. Cause and outcome of atypical chest pain in patients admitted to hospital. Am J Emerg Med. May 2014;32(5):421-31.
Sickle Cell Disease Module
Don't Forget the Bubbles
JULY 5, 2023
Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.
The EARLY TAVR Trial Exposes the Main Tension in Medical Science
Sensible Medicine
NOVEMBER 11, 2024
Medical scientists would design and conduct experiments to answer important questions, say, whether a drug or surgery, improves an outcome. The outcome would not matter because knowledge is gained from either a negative or positive result. Bottom left is stroke—also not significantly different.
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Grand Rounds Recap 8.9.23
Taming the SRU
AUGUST 25, 2023
wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1
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The Business Aspects of Establishing a Novel Service Line in the Emergency Department
ACEP Now
FEBRUARY 11, 2025
2 As the ACEP considers ultrasound guided regional anesthesia a core skill, this leaves a unique opportunity for hospital systems to leverage emergency physicians to provide these services in the inpatient and outpatient setting. Rib fractures are a condition that we commonly treat with ultrasound-guided nerve blocks.
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