EMDocs

JUNE 8, 2023

This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 78

Stroke Administration Outcomes Documentation/Coding 78

Ultrasound Gel

NOVEMBER 23, 2020

Well - that very well may be the case, but hear me out- this is a fascinating idea. This article presents a novel strategy for searching for embolic etiologies in the acute phase of ischemic strokes (which means even climbing into CT with a handheld device!). I know your first thought - is this for real?! you may rightfully ask.

Stroke 52

Stroke Wellness 52

ACEP Now

MAY 9, 2024

The clinical policy on the management of adult patients presenting to the emergency department (ED) with acute ischemic stroke, was approved by the ACEP Board of Directors in April 2023. You can find it on ACEP’s website, www.acep.org/clincialpolicies , as well as in the ECRI Guidelines Trust. Level B recommendations: None specified.

Stroke 52

Stroke Wellness Emergency Department Hospitals 52

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 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 N Engl J Med.

Stroke 67

Stroke Outcomes Operations Hospitals 67

Emergency Live

AUGUST 9, 2024

Besides causing the most well-known headaches, nausea and dizziness, they can have very serious consequences, especially on the liver. “Heat stroke” lethal for our body […] The post Heat stroke: a serious risk for the liver appeared first on Emergency Live.

Stroke 52

Stroke Wellness 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

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. I’ve already told you that peri-device leaks are associated with an increase in stroke risk.

Stroke 132

Stroke Outcomes Ultrasounds Wellness 132

The Skeptics' Guide to EM

AUGUST 20, 2022

Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile? I knew about Jeff from his multiple publications in the stroke literature. first appeared on The Skeptics Guide to Emergency Medicine. This is an SGEM Xtra.

Stroke 52

Stroke Best Practices EMS Research 52

EM Literature of Note

DECEMBER 4, 2024

In modern parlance, “diagnostic errors” become “missed opportunities for diagnosis” (MODs), and well-meaning researchers are devising further methods to shine bright lights upon our inadequacies. For this “stroke” example, 47 of the 100 patients reviewed were identified to have had MODs.

Emergency Department 92

Emergency Department Stroke Patient Safety Research 92

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

A 90-something year old woman presented with an acute mild stroke. Instead — there are deep anterior S waves (ie, 20-25 mm in leads V1,V2 ) — as well as a prominent initial R wave in lead V1 and surprisingly tall ( = 10 mm ) R wave already by lead V2 — suggesting at the least LVH , and possible increased septal forces.

Stroke 74

Stroke EKG/ECG Wellness 74

Stop and Think

DECEMBER 29, 2023

For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. Edoxaban reduced the primary endpoint of stroke, systemic embolism, and cardiovascular death by 19% (HR, 0.81; 95% CI, 0.60-1.08; hours) to edoxaban vs placebo. I don’t know.

Stroke 90

Stroke Research EKG/ECG Wellness 90

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. 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. Exclusion Criteria: Patients under 18 years of age.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Sensible Medicine

AUGUST 28, 2023

I describe it here for two reasons: it is an example of well-conducted unbiased study, and it deals with an increasingly common problem of short-duration episodes of atrial fibrillation. Some background: In patients with certain risk factors, AF increases the risk of having a stroke. The incidence of stroke was 0.9%

Stroke 90

Stroke Wellness EKG/ECG Outcomes 90

ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. The patient is anti-coagulated and does well. His blood pressure is 190 over 115.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

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

AENJ: Current Issue

JULY 31, 2024

Stroke-like symptoms are a common complaint in the emergency department; however, signs of an acute cerebrovascular event in a patient under the age of 50 can be both alarming and unexpected. Originally deemed a “stroke code” in the field, the patient was immediately transferred to the computerized tomography scanner.

Stroke 42

Stroke Documentation/Coding Emergency Department Wellness 42

EM Literature of Note

MARCH 9, 2021

As we are well aware, a brain globally deprived of oxygen, for even the briefest moments, suffers irreversible damage. ” 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.

Stroke 40

Stroke Outcomes Wellness 40

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. A systematic review and meta-analysis. Emerg Med Australas 2016.

Stroke 52

Stroke Outcomes Wellness 52

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

Sensible Medicine

OCTOBER 2, 2023

The authors chose to measure a primary outcome of death, myocardial infarction, stroke or repeat revascularization (either more stent procedures or surgeries). Curious for two reasons: First, instead of focusing on what happened with the primary outcome of death, MI, stroke and repeat procedures, they reported a slightly different outcome.

Stroke 106

Stroke Outcomes Wellness 106

PulmCCM

SEPTEMBER 28, 2023

In most of these studies, diagnostic imaging was only performed on patients at higher pretest probability for PE according to Wells criteria or other risk stratification. In the new era of thrombectomy for ischemic strokes with large vessel occlusion, however, some early data suggested lower blood pressure targets might be advisable.

COPD 95

COPD Stroke Academics Urgent Care 95

Sensible Medicine

JUNE 28, 2024

She is admitted with suspected stroke. 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. “Well, this isn’t really the aspect of my specialty that I specialize in.”

Stroke 94

Stroke Academics Hospitals EKG/ECG 94

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

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. She was last seen well two hours prior. There is no previous history of stroke. Reference: Juergens et al.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

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. It turns out the device performed less well during the pandemic. P-value now 0.049.

Stroke 124

Stroke Ultrasounds Outcomes Hospitals 124

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Sensible Medicine

JUNE 17, 2024

Europeans do PFA ablation in well under an hour. 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. Americans can’t seem to replicate that.

Shock 130

Shock Stroke Operations Ultrasounds 130

Sensible Medicine

NOVEMBER 28, 2023

Being perfectly honest, not all the articles have aged well. First, it renewed my faith that occasionally well-done studies address interesting and important questions. The primary outcome was stroke or systemic embolism and the primary safety outcome was major bleeding. There are some, however, that I remain proud of.

Stroke 82

Stroke Academics Outcomes Administration 82

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. The amount of blood that comes from the heart with each contraction is the stroke volume (SV).

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Sensible Medicine

AUGUST 26, 2024

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. What we want to know is whether that reduction in AF produces a placebo-resistant effect of improved well being. Plus, many patients have symptoms from AF.

Stroke 85

Stroke Outcomes Shock Research 85

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. The expanded window of 3-4.5 hours increased the NNT for a good outcome to 20.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

The Skeptics' Guide to EM

OCTOBER 3, 2020

Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. NEJM […] The post SGEM#303: Two Can Make It – Less likely to have another stroke but more likely to have a bleed (THALES Trial) first appeared on The Skeptics Guide to Emergency Medicine. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.

Stroke 40

Stroke Emergency Department Research Wellness 40

Taming the SRU

JULY 24, 2024

Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world. They then tested the LASSO model using the remaining 20% of data to see how well it could detect sepsis at the same time points.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Sensible Medicine

MAY 13, 2024

Since readers of Sensible Medicine are well versed in the tragic story of anti-arrhythmic drugs to treat PVCs after MI or hormone replacement therapy in post-menopausal women to prevent cardiac events, I know that you know that acceptance of a therapy by the medical establishment does not equal supporting evidence. I can’t explain it.

Stroke 68

Stroke Wellness 68

RebelEM

SEPTEMBER 14, 2023

bleeding, stroke, limb ischemia, and hemolysis). Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients. The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. The evidence for this practice has been sparse until now. Zeymer HT et al. Control: 53.4%

Shock 136

Shock Outcomes Resuscitation Stroke 136

Sensible Medicine

NOVEMBER 13, 2023

We call the primary endpoint of SELECT—CV death, MI or stroke—a hard cardiovascular endpoint. There were other positive results as well. But this study shows that a weight lost drug (perhaps through other mechanisms as well) reduces hard cardiac outcomes. Meaning this was a secondary prevention study.) mg) vs 8.2%

Outcomes 111

Outcomes Stroke Wellness Research 111

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98