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Specialty: Emergency Medicine
Procedure: Perfusion

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Total 45 results found since Jan 2013.

Mobile Stroke Units: A Device in Search of an Indication
If you've been to any regional or national EMS conference in the last two years, you've seen these mobile stroke units. They are beautiful large ambulances with the latest and greatest in modern technology including mobile CT scanners. Often, the name of a hospital is blazoned on the side. There is usually a staff member present to tell you how great these will be for your community. But are they? Where's the science? What's the cost? These are important questions that should be asked and answered before these devices are deployed on a widespread basis. Although still somewhat controversial, therapies are now available to ...
Source: JEMS Patient Care - January 12, 2017 Category: Emergency Medicine Authors: Bryan Bledsoe, DO, FACEP, FAEMS Tags: Patient Care Source Type: news

Effect of Pre-Hospital Workflow Optimization on Treatment Delays and Clinical Outcomes in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
CONCLUSIONS: This systematic review and meta-analysis found that PSWO significantly improves several time metrics related to stroke treatment leading to improvement in IVT reperfusion rates. Thus, the implementation of these measures in stroke networks is a promising avenue to improve an often-neglected aspect of the stroke response. However, the limited available data suggest functional outcomes and mortality are not significantly improved by PSWO, hence further studies and improvement strategies vis a vis PSWOs are warranted. PMID: 33387368 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 2, 2021 Category: Emergency Medicine Authors: Chowdhury SZ, Santana Baskar P, Bhaskar S Tags: Acad Emerg Med Source Type: research

Seizure in code stroke: Stroke mimic and initial manifestation of stroke
The objective of this study was to analyze the frequency, characteristics and results of neuroimaging including CT perfusion in patients with seizures manifesting initially as stroke-like symptoms.
Source: The American Journal of Emergency Medicine - December 27, 2018 Category: Emergency Medicine Authors: Soo Jeong Kim, Dong Wook Kim, Hahn Young Kim, Hong Gee Roh, Jeong-Jin Park Source Type: research

An acute stroke CT imaging algorithm incorporating automated perfusion analysis
AbstractIn this paper, we propose a CT imaging algorithm for patients presenting with suspected acute stroke that incorporates automated CT perfusion  (CTP) imaging. The algorithm details evaluation of the non-contrast CT (NCCT) for hemorrhage and acute ischemia, calculation of ASPECTS, with performance and interpretation of CTP if appropriate. In particular, we consider the key steps in expeditious interpretation of non-contrast CT and CT angi ography in the context of suspected acute ischemic stroke. Given the recent expansion of the “imaging based” treatment window for thrombectomy from 6 to 24 h in the 2018 Amer...
Source: Emergency Radiology - February 1, 2019 Category: Emergency Medicine Source Type: research

Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke
We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Chen-Hsiung Huang, Hui-Chun Huang, Kang-Hsu Lin, Wei-Kung Chen, Chon-Haw Tsai Tags: Case Reports Source Type: research

Imaging of acute ischemic stroke
This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized contr olled trials and national consensus guidelines.
Source: Emergency Radiology - July 6, 2018 Category: Emergency Medicine Source Type: research

Implementation Challenges of Regionalized Acute Stroke Care.
This article is protected by copyright. All rights reserved. PMID: 30663835 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 21, 2019 Category: Emergency Medicine Authors: Asimos AW Tags: Acad Emerg Med Source Type: research

Evaluation and Management of the Child With Suspected Acute Stroke
Pediatric stroke occurs at an incidence of 1.6 to 13/100 000 and may be acute ischemic, hemorrhagic, or of sinus venous thrombosis etiology. As these children present to the emergency department, early consideration for this diagnosis is paramount in beginning medical management to optimize cerebral perfusion and minimize secondary injury. There are many identified risk factors in pediatric stroke including arteriopathies, cardiac disease (specifically congenital heart disease), and infection. Modifiable adult risk factors including hypertension, hyperlipidemia, and diabetes are rarely seen in pediatrics.
Source: Clinical Pediatric Emergency Medicine - February 4, 2015 Category: Emergency Medicine Authors: Lindsey Morgan Source Type: research

CT Profile Flags Stroke Patients Who May Have More TimeCT Profile Flags Stroke Patients Who May Have More Time
Stroke patients found on CT perfusion imaging to have distinctive brain anatomy show good outcomes with intervention even after the 6-hour window. Medscape Medical News
Source: Medscape Emergency Medicine Headlines - February 19, 2016 Category: Emergency Medicine Tags: Neurology & Neurosurgery News Source Type: news

Too Good to Treat? Ischemic Stroke Patients with Small Computed Tomography Perfusion Lesions May Not Benefit from Thrombolysis
Clinical evidence has demonstrated that alteplase given within 4.5 hours of onset of ischemic stroke is beneficial. Noncontrast computed tomography (NCCT) in ischemic stroke is unable to discern potential responders and non-responders to alteplase. In the DEFUSE 2 and SWIFT PRIME trials, perfusion CT (CTP) identified patients likely to benefit from acute reperfusion therapy and those considered poor candidates for reperfusion due to the size of infract core or absence of viable tissue. In these investigations, intracranial lesions
Source: The Journal of Emergency Medicine - November 23, 2016 Category: Emergency Medicine Authors: John Michael Rague Source Type: research

Misleading CT perfusion in subacute ischemic stroke
AbstractThe RAPID © software is the most commonly used computed tomography perfusion (CTP) software in stroke centers. It is estimated that about 1300 hospitals in the world are using this software for decision-making in ischemic stroke. The software provides the estimated volume of infarction and ischemic penumbra, so it is the backbone of treatment planning in these patients. In this manuscript, we present two cases of subacute infarction with misleading CTP using RAPID© software. We believe that given the popularity of this software and increasing application of CTP in subacute infarction, this pitfall is likely under...
Source: Emergency Radiology - August 19, 2019 Category: Emergency Medicine Source Type: research

A Helpful Tool in Diagnosing Stroke Mimics: Arterial Spin Labeled Perfusion Magnetic Resonance Imaging
Prompt and effective management of acute ischemic stroke in the emergency setting requires a high level of suspicion and accurate diagnosis. Conversely, identifying stroke mimics can be challenging, given the similarity of their clinical symptomatology, the necessary rapid assessment and triage, and the overall frenetic pace inherent in the goal of rapid thrombolysis ( “time is brain”).
Source: The Journal of Emergency Medicine - March 17, 2020 Category: Emergency Medicine Authors: Michael U. Antonucci, Milad Yazdani Tags: Selected Topics: Emergency Radiology Source Type: research

Effect of Tight Glycemic Control on Patients with Ischemic Stroke.
Abstract Hyperglycemia in the setting of acute ischemic stroke is associated with increased mortality and worse neurological outcome.1 Multiple mechanisms exist by which hyperglycemia may worsen ischemic brain injury, including increased inflammatory stress, calcium imbalance, accumulation of reactive oxygen species, and decreased blood perfusion, but it is unclear if treating hyperglycemia can improve brain injury. PMID: 32426891 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - May 18, 2020 Category: Emergency Medicine Authors: Long B, Koyfman A, Gottlieb M Tags: Acad Emerg Med Source Type: research

The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated p...
Source: Emergency Medicine Journal - January 15, 2014 Category: Emergency Medicine Authors: Alikhan, R., Rayment, R., Keeling, D., Baglin, T., Benson, G., Green, L., Marshall, S., Patel, R., Pavord, S., Rose, P., Tait, C. Tags: Poisoning/Injestion, Open access, Drugs: cardiovascular system, Stroke, Poisoning Review Source Type: research

Computed tomography perfusion-based thrombolysis in wake-up stroke
Abstract Wake-up stroke (WUS) patients are typically excluded from reperfusion treatment, as the time of symptoms onset is unknown. The purpose of this study is to evaluate the clinical outcome and safety of intravenous thrombolysis with rt-PA in patients with WUS eligible for therapy using computed tomography perfusion criteria (CTP), compared to patients treated with rt-PA within 4.5 h of symptoms onset (non-WUS). This is an experimental, open-label trial, controlled against the best therapy currently in use. Primary endpoints were functional independence after 3 months [modified Rankin scale (mRS) ≤ 1] ...
Source: Internal and Emergency Medicine - September 14, 2015 Category: Emergency Medicine Source Type: research