PulmCCM

NOVEMBER 11, 2021

To focus matters, the hemodynamic variable under consideration is the stroke volume [SV]; in other words, how does a push of phenylephrine affect SV? ’ Diminished stroke volume? In the former group, stroke index [i.e., SV] increased significantly, while in the latter group, stroke index fell in response to phenylephrine.

Stroke 40

Stroke Sepsis Administration Wellness 40

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. What’s New in Stroke Care?

Research 52

Research Airway Management Stroke Outcomes 52

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 71

Stroke Outcomes EMS Seizures 71

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

ACEP Now

AUGUST 25, 2023

The National Heart, Lung, and Blood Institute released an expert panel report in 2014 with evidence-based guidelines for management of SCD recommending timely administration of parenteral opioids for VOE.2 Two interesting findings were time to parenteral opioid administration and total dose of opioid morphine equivalents. Am J Hematol.

Administration 97

Administration Pediatrics Outcomes Emergency Department 97

Sensible Medicine

NOVEMBER 28, 2023

People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators. [i] The primary outcome was stroke or systemic embolism and the primary safety outcome was major bleeding. years, anticoagulation reduced the rate of stroke or systemic embolism by 1.7% (HR: 0.63; 0.45

Stroke 81

Stroke Academics Outcomes Administration 81

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 72

EMS Stroke Outcomes Hospitals 72

EMDocs

SEPTEMBER 6, 2023

Learning points: Consider differential – sepsis, thyroid storm, thalamic stroke, exertional and classic heat stroke, serotonin syndrome, neuroleptic malignant syndrome, sympathomimetic toxicity, and anticholinergics. Reference: EM@3AM – Heat Stroke Case 2: 40-year-0ld female feels unwell but no other specific complaints.

Anaphylaxis 69

Anaphylaxis Shock Sepsis Stroke 69

The Skeptics' Guide to EM

JANUARY 1, 2022

Prospective, multicenter, controlled trial of mobile stroke units. Date: December 21st, 2021 Guest Skeptic: Dr. Prospective, multicenter, controlled trial of mobile stroke units. Background: No one who has listened to the SGEM will be surprised we are covering another paper looking at stroke. Reference: Grotta JC et al.

Stroke 52

Stroke EMS Outcomes Administration 52

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). Aspirin is sometimes given during the waiting period.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

EM Literature of Note

SEPTEMBER 9, 2021

It has apparently become time for the mobile stroke unit to go from niche to prime-time. Previously consigned to the pages of Stroke and similar journals, the latest and most comprehensive trial now graces the pages of the New England Journal of Medicine. A flagship study for a flagship journal.

Stroke 40

Stroke Telemedicine EMS Administration 40

The Skeptics' Guide to EM

JUNE 17, 2023

The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7] IN fentanyl has been safely used to treat pain in pediatric patients.

Emergency Department 70

Emergency Department Pediatrics Administration Head Injuries 70

Emergency Medicine Ireland

APRIL 29, 2024

Hopefully what follows will provide enough broad brush strokes to get you through a night on call or even worse a viva. I will say that once the hypertonic is in and you’re reaching for a 2nd or a 3rd you should probably be thinking about a CVC as the access for administration and indeed regular sampling is really helpful.

Seizures 75

Seizures Sepsis Stroke Administration 75

JournalFeed

APRIL 9, 2022

Spoon Feed: IV Vitamin C (IVVC) administration appeared to be safe and reduced overall mortality in this meta-analysis of critically ill patients, when given in higher doses and as monotherapy. These are summaries from just 2 of the 5 article we cover every week! Vit-C = good?

Stroke 40

Stroke Administration 40

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? Article: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 99

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 99

The Skeptics' Guide to EM

JUNE 5, 2021

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. Background: Management of acute ischemic stroke has been discussed on the SGEM ever since this knowledge translation project was launched in 2012.

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Myth busting: Is peripheral administration safe? 2021;25(1):146.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Taming the SRU

DECEMBER 6, 2023

ems grand rounds: southwest ohio protocol updates WITH dr. weekley Ideally, medications will be administered IV or IO, therefore endotracheal tube drug administration will be de-emphasized. With rare exception, patients with sICH should be admitted to a specialized stroke unit (NSICU).

Leadership 54

Leadership Stroke Airway Management Administration 54

Taming the SRU

FEBRUARY 12, 2024

Given her intracranial hemorrhages, significant attempts were made to improve coagulation including administration of IV vitamin K, 3 units of fresh frozen plasma, and administration of four-factor prothrombin complex concentrate (PCC, Kcentra). However, crucially, this assay must be calibrated to the agent of interest. [8]

Administration 71

Administration Fractures Anaphylaxis Emergency Department 71

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Background: The issue of thrombolytics for stroke has been debated since at least 1995. Date: May 19th, 2020 Reference: Yang P et al.

Stroke 40

Stroke EMS Administration Wellness 40

RebelEM

SEPTEMBER 28, 2023

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e.

EKG/ECG 127

EKG/ECG Allergic Reactions Shock Stroke 127

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke). If so, could this be done safely? JAMA Neurol. 2021;78(3):338–345.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 84

Sepsis Administration Documentation/Coding Fractures 84

RebelEM

MAY 18, 2023

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Read more

Sepsis 83

Sepsis Shock Resuscitation Outcomes 83

EMDocs

NOVEMBER 20, 2023

For patients on VKAs to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor prothrombin complex concentrate (PCC) is preferred to fresh frozen plasma (FFP) because of the rapidity of INR reduction (Conditional recommendation, very low-quality evidence). Strong recommendation, moderate quality evidence).

Resuscitation 78

Resuscitation Fluid Resuscitation Hospitals Research 78

The Skeptics' Guide to EM

APRIL 6, 2019

He reports he has been taking apixaban to prevent stroke in the context of atrial fibrillation, which you easily recognize as one of the modern oral anti-Factor Xa inhibitors. This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran. Dabigatran is a direct thrombin inhibitor.

Stroke 52

Stroke Administration EMS Wellness 52

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. PCI) in STEMI Early administration of aspirin decreases mortality and complications of MI (all types). (19), Part 2 : Why do we care? This can be the result of hypotension, tachycardia, sepsis, PE, etc.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And so was an appropriate anti-coagulant, since atrial flutter, like fibrillation, can result in thromboembolism and stroke. The above said — WHY did the atrial rate become faster after administration of an IV ß-blocker? This could be a beta blocker such as metoprolol, or a calcium channel blocker such as diltiazem.

EKG/ECG 115

EKG/ECG Stroke Wellness Administration 115

RebelEM

MARCH 22, 2023

An alternate administration approach can be found on ALiEM. Valsalva maneuvers Have patient bear down as if they are having a bowel movement Have patient blow as hard as they can into a straw Syringe technique Postural Modification Success rate: 43% vs. 17% (standard Valsalva) (Appleboam 2015) Details of technique found at the St.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

ACEP Now

OCTOBER 3, 2023

This guideline revision is particularly timely as EMS systems have shown their abilities to dramatically improve survival and neurologic outcome after cardiac arrest, STEMI, acute stroke, and other time-sensitive conditions. References Lulla A, et al. Prehospital Guidelines for the management of traumatic brain injury – 3rd edition.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

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.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EM Literature of Note

JULY 4, 2022

This article pertains to the practice of telestroke administration of thrombolysis for acute ischemic stroke. In major hospital centers, there may be in-house neurology hospitalists or stroke and vascular specialists, and the expertise for management of stroke is readily at the bedside. of their series are stroke mimics.

Stroke 40

Stroke Academics Hospitals Administration 40

Critical Care Now

MAY 12, 2022

The Pre-brief When we think of lysing things in the emergency department (ED), we think of alteplase busting up a blood clot in either ischemic stroke or in patients experiencing a massive pulmonary embolism. Interests include trauma, toxicology, and infectious diseases. Another lytic that is used in the ED is docusate for cerumen impaction.

Infectious Diseases 52

Infectious Diseases Stroke Administration Emergency Department 52

ACEP Now

JULY 6, 2023

Now, many PID patients are treated and released after ED administration of appropriate antibiotics to eradicate possible infection by Neisseria gonorrhea and Chlamydia trachomatis , often with added treatment for anaerobic microbes. Acute pyelonephritis has become a disease for which outpatient management is often feasible and appropriate.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Don't Forget the Bubbles

JUNE 30, 2023

Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). in the TXA group vs 53.7% in the placebo group). This study moves trauma care beyond just ‘survival’.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

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

Administration 124

Administration Outcomes Resuscitation Radiology 124

Taming the SRU

AUGUST 25, 2023

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.)

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66