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Management of Acute Ischemic Stroke
Conclusions: Appropriate treatment of ischemic stroke is essential in the reduction of mortality and morbidity. Management of stroke involves a multidisciplinary approach that starts and extends beyond hospital admission.
Source: Critical Care Medicine - October 14, 2020 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Cannabis-Associated Stroke Presentations: No Smoke Without a Fire
We read with great interest the first-ever case reported by Dr. Finch and Dr. Vilke regarding the tetrahydrocannabinol (THC) edible ingestion resulting in an acute stroke (1). We agree that this is a unique case of focal neurological deficits occurring in the setting of THC ingestion, and also, it is hard to deliberate that intoxication timing and an episode of transient ischemic attack was just an accidental co-occurrence. Interestingly, in our prior studies using nationally representative cohorts of cannabis users, we observed a positive association between cannabis use and the rising frequency of stroke admissions in th...
Source: The Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Authors: Rupak Desai, Tarang Parekh Tags: Letters to the Editor Source Type: research

How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke
Acute ischemic strokes account for 85% of all strokes and are the fifth leading cause of mortality in the United States. About one in five of all ischemic strokes occur during sleep and are not noticed until the patient wakes up with neurological deficits. There is growing evidence to support that a significantly higher number of stroke patients could benefit from more aggressive care, especially those patients who wake up with strokes. There is increasing research to support a physiologically-based approach based on advanced imaging rather than simply a time-based determination of whether or not a patient would benefit from reperfusion.
Source: The American Journal of Emergency Medicine - February 21, 2019 Category: Emergency Medicine Authors: Danielle Biggs, Michael E. Silverman, Frank Chen, Brian Walsh, Peter Wynne Source Type: research

Do High Sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
CONCLUSION: HscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope. This article is protected by copyright. All rights reserved. PMID: 30721554 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - February 5, 2019 Category: Emergency Medicine Authors: Clark CL, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC Tags: Acad Emerg Med Source Type: research

Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Debilitating Headache after an Excited Reaction
​BY GREGORY TAYLOR, DO, & MATTHEW WARPINSKI, DOA 35-year-old man with a history of uncontrolled hypertension and medical noncompliance was brought to the emergency department by EMS complaining of a headache. The family said the patient was watching football and developed an acute headache after he stood up screaming in excitement.His family said he had not taken his blood pressure medication for years. He was afebrile, his blood pressure was 245/129 mm Hg, his respiratory rate was 18 bpm, his heart rate was 68 bpm, and he weighed 340 pounds. The patient was obtunded with a Glasgow Coma Scale score of 4 and was subse...
Source: The Case Files - November 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence
Acute ischemic stroke is leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.
Source: The American Journal of Emergency Medicine - November 14, 2018 Category: Emergency Medicine Authors: Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, Kevin Kaucher Source Type: research

Acute Stroke: From Prehospital Care to In-Hospital Management
Early recognition of stroke by clinical presentation and prehospital stroke assessment tools facilitate rapid prehospital and ED diagnosis. CanStockPhoto/focalpoint   Stroke is a leading cause of morbidity and mortality in the United States and requires prompt recognition by prehospital providers to ensure rapid transport. Stroke can present in a variety of different ways, some more readily apparent than others. Delays in diagnosis and treatment can have devastating effects on the outcomes for these patients. In this article, we describe a patient who initially presented with altered mental status and was subsequent...
Source: JEMS Patient Care - May 2, 2018 Category: Emergency Medicine Authors: Henry G. Colmer IV, MD Tags: Patient Care Cardiac & Resuscitation Source Type: news

Neurology Concepts: Young Women and Ischemic Stroke —Evaluation and Management in the Emergency Department
ConclusionUnique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
Source: Academic Emergency Medicine - October 10, 2017 Category: Emergency Medicine Authors: Bernard P. Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E. Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen Tags: Original Contribution Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Tags: Case Report Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Case report of an intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Source Type: research