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EM@3AM: Brainstem Strokes

EMDocs

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?

Stroke 107
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Tools you should use: Pediatric NIH Stroke Scale

PEMBlog

Pediatric strokes are rare and challenging to diagnose. There is a validated Pediatric Stroke Scale from the NIH that can be used in conjunction with a stroke protocol that involves Neurology, Radiology, and a local/regional Stroke Team. Early consultation with a pediatric hematologist and neurologist is mandatory.

Stroke 59
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What Are the Classifications of Perinatal Stroke?

Pediatric Education

She had a history of neonatal stroke for which she had received physical and occupational therapy. The mother and medical records confirmed that a cause had not been determined but the child had a neonatal arterial ischemic stroke. The mother had been evaluated for hypercoagulability which was negative.

Stroke 52
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Contrast Media Shortage of 2022 – Lessons Learned

EMDocs

2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. In most cases, the radiology team functioned as the main decision-maker playing a key role in drafting institutional protocols. 11 Table 1.

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The PROPHY-VAP Trial: Ceftriaxone to Prevent VAP in Patients with Acute Brain Injury

RebelEM

3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. Post-stroke infection: a systematic review and meta-analysis. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. Westendorp, W.

CDC 111
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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

E.g. burns, neurosurgery, interventional radiology. It can cause significant internal injuries, including carotid artery dissection, stroke, and acquired brain injury, but in 50% of patients, there are no external signs of injury. Clinical Radiology: Major paediatric trauma radiology guidance. link] Sardinha, L.

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

RebelEM

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72