RebelEM

JULY 27, 2023

Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke.

Stroke 98

Stroke Outcomes EMS Hospitals 98

EMDocs

JUNE 8, 2023

This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? Intervention: Alteplase 0.9 in alteplase group versus 0.9% to 53.54, p=0.053).

Stroke 96

Stroke Administration Documentation/Coding Outcomes 96

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 89

Stroke Outcomes Operations Hospitals 89

EM Ottawa

MAY 6, 2024

Editorial: Expanding Treatment for Acute Ischemic Stroke beyond Revascularization.

Stroke 63

Stroke Outcomes 63

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 134

Stroke Outcomes Ultrasounds Wellness 134

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 123

Stroke Outcomes 123

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 124

Stroke Outcomes Wellness 124

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 75

Stroke Shock Wellness Outcomes 75

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 58

Stroke Outcomes 58

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

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

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 114

Stroke Outcomes Wellness 114

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 123

Seizures Stroke Outcomes Research 123

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

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 102

Stroke Outcomes Hospitals 102

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 105

Stroke EMS Administration Ultrasounds 105

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

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

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 94

Stroke Outcomes EMS Seizures 94

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 Administration 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

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 122

Stroke Outcomes Hospitals Wellness 122

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

EMDocs

SEPTEMBER 3, 2024

Secondary: % change from baseline in anti-factor Xa activity during the first 2 hours from randomization Safety (assessed at 30 days): thrombotic events (ischemic stroke, VTE, myocardial infarction), mortality Results: 452 patients analyzed for the primary outcome. 530 patients analyzed for safety outcome. doi: 10.1161/STR.0000000000000407.

Stroke 96

Stroke Outcomes Hospitals 96

EMDocs

AUGUST 17, 2024

. #1: TNK Up to 24 Hours for Stroke? Source Tenecteplase for Ischemic Stroke at 4.5 Spoon Feed In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months.

Stroke 92

Stroke Administration Outcomes 92

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

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 133

Stroke Outcomes Hospitals Administration 133

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

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 98

Stroke Hyperthermia / Hypothermia Outcomes Shock 98

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 95

EMS Stroke Outcomes Hospitals 95

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 101

Documentation/Coding Stroke Outcomes EMS 101

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. 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. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly.

Stroke 99

Stroke Outcomes Shock Research 99

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

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 133

Shock Outcomes Resuscitation Stroke 133

The Skeptics' Guide to EM

AUGUST 10, 2024

A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73).

Stroke 86

Stroke Airway Management Documentation/Coding Outcomes 86