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Specialty: Emergency Medicine
Condition: Hemorrhagic Stroke

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Total 233 results found since Jan 2013.

Compensatory Reserve Index Can Aid in Early Shock Detection
EARLY SHOCK DETECTION Convertino VA, Howard JT, Hinojosa-Laborde C. Individual-specific, beat-to-beat trending of significant human blood loss: The compensatory reserve. Shock. Jan. 6, 2015. [Epub ahead of print.] Hemorrhagic shock is the leading cause of death in trauma. The challenge is detecting shock early enough to intervene clinically. The human body is masterful at compensating with a variety of seemingly undetectable mechanisms, such as autonomic activity, vasoconstriction, increased stroke volume, improved cardiac filling and more efficient breathing. So by the time we see alterations in vital sign metrics, the...
Source: JEMS Special Topics - August 10, 2015 Category: Emergency Medicine Authors: Alexander L. Trembley, NREMT P Tags: Columns Cardiac & Resuscitation Special Topics Patient Care Source Type: news

Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage
Objectives: Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function health-related quality of life. Design: Patients with intracerebral hemorrhage were enrolled in a prospective cohort study. We performed mixed models for T-scores of health-related quality of life, referenced to the U.S. population at 50 ± 10, accounting for severity of injury and time to follow-up. ...
Source: Critical Care Medicine - August 16, 2018 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review*
Conclusions: These data from studies of neurocritically ill patients demonstrate that patients with primary neurologic diagnoses can meet diagnostic criteria for delirium and that delirious features may predict relevant untoward clinical outcomes. There is a need for ongoing investigations regarding delirium in these complicated neurocritically ill patients.
Source: Critical Care Medicine - October 13, 2018 Category: Emergency Medicine Tags: Review Article Source Type: research

Beneficial Effects of Adrenal Androgen Supplement in Bleeding Cirrhotic Rats
In conclusion, androgen deficiency exists in bleeding cirrhotic rats. DHEA augments terlipressin-induced amelioration of shock without influencing splanchnic hemodynamics, possibly rendering it a feasible adjunct to vasoconstrictors in variceal hemorrhage.
Source: Shock - November 14, 2018 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Spontaneous Retroperitoneal Hemorrhage
A 68-year-old man was admitted for pneumonia. Three months earlier he had suffered an embolic ischemic stroke related to newly diagnosed atrial fibrillation. He had residual aphasia, right hemiparesis with hemianesthesia, and was treated with subcutaneous enoxaparin 60  mg twice daily at the time of admission. Initial laboratory tests showed a white blood cell count of 12.480/mm3 and a hemoglobin level of 12.6 g/dL.
Source: The Journal of Emergency Medicine - March 13, 2019 Category: Emergency Medicine Authors: Christodoulos Dolapsakis, Vasiliki Giannopoulou, Evgenia Grivakou Tags: Visual Diagnosis in Emergency Medicine Source Type: research

A Fate Worse Than Death: Prognostication of Devastating Brain Injury
Conclusions: Intensivists should consider the modern literature describing prognosis for devastating brain injury and provide appropriate time for patient recovery and for discussions with the patient’s surrogates. Surrogates wish to have a prognosis enumerated even when uncertainty exists. These discussions must be handled with care and include admission of uncertainty when it exists. Respect for patient autonomy remains paramount, although physicians are not required to provide inappropriate medical therapies.
Source: Critical Care Medicine - March 16, 2019 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review.
CONCLUSION: More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool. PMID: 31006937 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - April 21, 2019 Category: Emergency Medicine Authors: Viau JA, Chaudry H, Hannigan A, Boutet M, Mukarram M, Thiruganasambandamoorthy V Tags: Acad Emerg Med Source Type: research

Real-world 2-year outcome of atrial fibrillation treatment with dabigatran, apixaban, and rivaroxaban in patients with and without chronic kidney disease
AbstractPatients with non-valvular atrial fibrillation (NVAF) and chronic kidney disease (CKD) are at increased risk of stroke and bleeding. Although direct oral anticoagulant (DOAC) trials excluded patients with severe CKD, a growing portion of CKD patients have been starting DOACs and limited data from real-world outcome in this high-risk setting are available. The INSigHT registry included 632 consecutive NVAF patients that started apixaban (256 patients, 41%), dabigatran (245, 39%) and rivaroxaban (131, 20%) between 2012 and 2015. Based on creatinine clearance, two sub-cohorts were defined: (1) non-CKD group (CrCl 60 ...
Source: Internal and Emergency Medicine - May 8, 2019 Category: Emergency Medicine Source Type: research

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding.
Source: The American Journal of Emergency Medicine - May 13, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn Source Type: research

Enhanced Renal Clearance in Patients With Hemorrhagic Stroke*
Objectives: To evaluate enhanced renal clearance over time in patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage via measured creatinine clearance and to compare measured creatinine clearance to creatinine clearance calculated by the Cockcroft-Gault equation and estimated glomerular filtration rate calculated by the Modification of Diet in Renal Diseases equation. Design: Prospective, observational study. Setting: Neurosciences ICU in a tertiary care academic medical center. Patients: Study participants had an admission diagnosis of aneurysmal subarachnoid hemorrhage or intracerebral he...
Source: Critical Care Medicine - May 16, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Letter to: “Usefulness of Cerebral rSO2 Monitoring During CPR to Predict the Probability of Return of Spontaneous Circulation”
The recent study by Ryosuke Takegawa, et al. is commendable and contributes much to the subject matter [1]. We assent to the previous opinion that rSO2 might be useful in predicting the neurologic outcomes of cardiac arrest (CA) victims. However, we still doubt about the usefulness of ΔrSO2for the prediction of return of spontaneous circulation (ROSC) concluded by Ryosuke Takegawa, et al, since we thought the significance of correlation between ΔrSO2 and ROSC might depend on the causes of CA. For example, its usefulness might become asthenic in the prediction of ROSC in large i schemic and hemorrhagic stroke caused CA.
Source: Resuscitation - July 8, 2019 Category: Emergency Medicine Authors: Yarong He, Peng Yao, Yong Xie, Yu Cao Tags: Letter to the Editor Source Type: research

Comment on: “Usefulness of cerebral rSO2 monitoring during CPR to predict the probability of return of spontaneous circulation”
The recent study by Ryosuke Takegawa et al. is commendable and contributes much to the subject matter.1 We assent to the previous opinion that rSO2 might be useful in predicting the neurologic outcomes of cardiac arrest (CA) victims. However, we still doubt about the usefulness of ΔrSO2for the prediction of return of spontaneous circulation (ROSC) concluded by Ryosuke Takegawa et al., since we thought the significance of correlation between ΔrSO2 and ROSC might depend on the causes of CA. For example, its usefulness might become asthenic in the prediction of ROSC in large i schemic and hemorrhagic stroke caused CA.
Source: Resuscitation - July 8, 2019 Category: Emergency Medicine Authors: Yarong He, Peng Yao, Yong Xie, Yu Cao Tags: Letter to the Editor Source Type: research

Retrospective Assessment of Desmopressin Effectiveness and Safety in Patients With Antiplatelet-Associated Intracranial Hemorrhage*
Conclusions: DDAVP was associated with a decreased likelihood of intracranial hemorrhage expansion during the first 24 hours. DDAVP administration did not significantly affect serum sodium and thrombotic events during the study period.
Source: Critical Care Medicine - November 16, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Deconstructing Poststroke Delirium in a Prospective Cohort of Patients With Intracerebral Hemorrhage*
Conclusions: Delirium is common after intracerebral hemorrhage, but severe neurologic deficits may confound its assessment and lead to underdiagnosis. The Intensive Care Delirium Screening Checklist’s inclusion of nonverbal features may make it more accurate than the Confusion Assessment Method for the ICU in patients with neurologic deficits, but novel tools designed for such patients may be warranted.
Source: Critical Care Medicine - December 14, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Early Maladaptive Cardiovascular Responses are Associated with Mortality in a Porcine Model of Hemorrhagic Shock
Conclusions: Despite similar initial changes in variables, we found that low CO, DBP, SV, DO2, SvO2, and high lactate are predictive of death in this animal model. The results of this experimental study suggest that maladaptive responses across a range of cardiovascular parameters that begin early after hemorrhage may be predictive of impending death, particularly in situations where early resuscitative treatment may be delayed.
Source: Shock - March 13, 2020 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research