A Paradigm Shift in EMS Evaluation Of Stroke

BackgroundMontgomery County Hospital District EMS (MCHD) is collaborating with the South East Texas Regional Advisory Committee (SETRAC) to validate their existing prehospital suspected neurological event guideline for stroke assessment and transport.MCHD is a non-fire based EMS service in Montgomery County, Texas. We respond to approximately 58,000 calls to service and identify stroke in more than 500 patients per year. Our EMS system covers an estimated 1,100-square-mile service area and has 190 medics, 900 EMTs and 15 first responder (FR) organizations.Acute ischemic stroke (AIS) is a debilitating and costly disease with few treatment options. On average in the U.S., a stroke occurs every 40 seconds and a death related to stroke every four minutes.1 To date, tissue plasminogen activator (Activase, or alteplase) has been the only FDA-approvedtreatment demonstrating improved clinical outcomes for AIS.2 – 5 There are compelling new data in carefully selected patients with large vessel occlusive (LVO) stroke that mechanical clot retrieval along with TPA may have a profound effect on the morbidity and mortality associated with AIS.6 – 9 It remains clear from the literature that timely care of acuteischemic stroke is associated with improved outcomes.6 – 9,10,11,15 – 18Acute care coordination in stroke is a complex and challenging task that many health systems struggle to master. The American Stroke Association (ASA) recommendation for developing systems ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Source Type: news

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ConclusionWe have constructed a stereotaxic template set of macaque brain named HJT, which standardizes macaque neuroimaging data analysis, supports novel radiotracer development and facilitates translational neuro-disorders research.
Source: NeuroImage - Category: Neuroscience Source Type: research
Publication date: Available online 11 October 2019Source: Life SciencesAuthor(s): Jenq-Lin Yang, Yun-Ru Yang, Shang-Der ChenAbstractStroke is the major cause of adult disability and the second or third leading cause of death in developed countries. The treatment options for stroke (thrombolysis or thrombectomy) are restricted to a small subset of patients with acute ischemic stroke because of the limited time for an efficacious response and the strict criteria applied to minimize the risk of cerebral hemorrhage. Attempts to develop new treatments, such as neuroprotectants, for acute ischemic stroke have been costly and tim...
Source: Life Sciences - Category: Biology Source Type: research
The objective of the study was to determine whether β-caryophyllene (BCP) exerts a neuroprotective effect in cerebral ischemia-reperfusion (I/R) injury by inhibiting microglial activation and modulating their polarization via the TLR4 pathway.Main methodsWild-type (WT) and TLR4 knockout (KO) C57BL/6J mice were subjected to cerebral I/R injury and neurologic dysfunction, cerebral infarct volume, brain edema, microglia activation and polarization, and TLR4 expression were determined. In vitro, primary microglia were stimulated with LPS and IFN-γ or IL-4 to induce polarization of microglia toward M1 or M2 phenotype...
Source: Life Sciences - Category: Biology Source Type: research
In conclusion, these results indicate that resveratrol decreases ischemia/reperfusion-induced neuronal apoptosis by downregulating the TGF-β-mediated ERK pathway in a rat model of cerebral hemorrhage and may serve as a potential agent for the treatment of cerebral hemorrhage. PMID: 31602214 [PubMed]
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
Conclusions: The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy. PMID: 31597907 [PubMed - as supplied by publisher]
Source: The Korean Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Korean J Intern Med Source Type: research
AbstractBackgroundAssessment of ‘high on-treatment platelet reactivity (HTPR)’ could enhance understanding of the pathophysiology of first or recurrent vascular events in carotid stenosis patients on antiplatelet therapy.MethodsThis prospective, multi-centre study assessed antiplatelet –HTPR status and its relationship with micro-emboli signals (MES) in asymptomatic vs. symptomatic ≥ 50–99% carotid stenosis. Platelet function/reactivity was assessed under ‘moderately high shear stress’ with the PFA-100® and ‘low shear stress’ with VerifyNow® and Multi...
Source: Journal of Neurology - Category: Neurology Source Type: research
AbstractClinical evidence suggests that patients with subcortical ischemic vascular dementia (SIVD) perform better at cognitive tests after exercise. However, the underlying mechanism for this effect is largely unknown. Here, we examined how treadmill exercise changes the cognitive function and white matter cellular pathology in a mouse model of SIVD. Prolonged cerebral hypoperfusion was induced in 2-month-old male C57BL/6J mice by bilateral common carotid artery stenosis. A week later, the mice were randomly divided into a group that received 6-week treadmill exercise and a sedentary group for observation. In multiple beh...
Source: Translational Stroke Research - Category: Neurology Source Type: research
Conclusions: Our findings suggest that greater post-regionalization improvements in San Mateo County contributed to significantly better county-level thrombolysis use than Santa Clara County. PMID: 31599705 [PubMed - as supplied by publisher]
Source: Prehospital Emergency Care - Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research
Background: Ischemic stroke (IS) is a leading cause of death and long-term disability worldwide. The NaoShuanTong capsule (NSTC), a traditional Chinese patent medicine, has been extensively used in the treatment of stroke in China. However, the clinical efficacy and safety of this treatment has not been statistically and systematically verified by any comprehensive pooled analysis. We therefore performed a meta-analysis to evaluate the efficacy and safety of NSTC in the treatment of IS.Methods: Randomized controlled trials (RCTs) of NSTC in the treatment of IS conducted before September 2018 were retrieved from five databa...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Objective: To examine racial/ethnic disparities in 30-day all-cause readmission after stroke. Methods: Thirty-day all-cause readmission was compared by race/ethnicity among Medicare fee-for-service beneficiaries discharged for ischemic stroke from hospitals in the Florida Stroke Registry from 2010 to 2013. We fit a Cox proportional hazards model that censored for death and adjusted for age, sex, length of stay, discharge home, and comorbidities to assess racial/ethnic differences in readmission.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
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