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Specialty: Emergency Medicine
Condition: Hemorrhagic Stroke
Management: Hospitals

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Total 30 results found since Jan 2013.

Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease*
OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologi...
Source: Critical Care Medicine - June 28, 2021 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

CNS Complications in Adult Patients Treated With Extracorporeal Membrane Oxygenation
Objectives: To describe the incidence and outcomes of radiologically confirmed acute CNS complications in extracorporeal membrane oxygenation patients at an Australian extracorporeal membrane oxygenation referral center and identify associated patient characteristics. Design: Retrospective cohort study. Setting: Single-center tertiary institution. Patients: Four-hundred twelve consecutive adult patients supported with extracorporeal membrane oxygenation from 2009 to 2017. Results: Fifty-five patients (13.3%) had a CNS complication confirmed by CT or MRI, including ischemic stroke (7.0%), int...
Source: Critical Care Medicine - January 16, 2021 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital
AbstractReduced incidence of stroke during COVID-19 pandemic was sometimes  reported. While decrease in stroke incidence and fear of patients to go to the hospitals were sometimes invoked to explain this decrease, reduction in urban pollution was also hypothesized as a possible cause. We investigated statistically the incidence of ischemic and hemorrhagic stroke, and of transient ischemic attacks, at a large Italian tertiary stroke center during the pandemic. We analyzed statistically the number of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) between March 8 and May 2, 2020, the pe...
Source: Internal and Emergency Medicine - October 15, 2020 Category: Emergency Medicine Source Type: research

Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry
Objectives: Although acute brain injury is common in patients receiving extracorporeal membrane oxygenation, little is known regarding the mechanism and predictors of ischemic and hemorrhagic stroke. We aimed to determine the risk factors and outcomes of each ischemic and hemorrhagic stroke in patients with venoarterial extracorporeal membrane oxygenation support. Design: Retrospective analysis. Setting: Data reported to the Extracorporeal Life Support Organization by 310 extracorporeal membrane oxygenation centers from 2013 to 2017. Patients: Patients more than 18 years old supported with a single run of venoar...
Source: Critical Care Medicine - September 12, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

SMASH-U classification: a tool for aetiology-oriented management of patients with acute haemorrhagic stroke
AbstractIntracerebral haemorrhage (ICH) is responsible for disproportionately high morbidity and mortality rates. The most used ICH classification system is based on the anatomical site. We used SMASH-U, an aetiological based classification system for ICH by predefined criteria: structural vascular lesions (S), medication (M), amyloid angiopathy (A), systemic disease (S), hypertension (H), or undetermined (U). We aimed to correlate SMASH-U classification of our patients to the intra-hospital mortality rates. We performed a single centre retrospective study at the Santa Maria Della Misericordia Hospital, Perugia (Italy) inc...
Source: Internal and Emergency Medicine - April 7, 2020 Category: Emergency Medicine Source Type: research

Outcomes of reperfusion therapy for acute ischaemic stroke in patients aged 90 years or older: a retrospective study
AbstractThe benefits and risks of acute reperfusion therapy (RT) in acute ischaemic stroke (AIS) remain uncertain in older patients, especially in nonagenarians. We aimed to assess the impact of RT in this population. Single-center retrospective cohort study comparing patients  ≥ 90 years old admitted to a Stroke Unit (2008–2018) with AIS, submitted or not to RT [intravenous thrombolysis(IVT), mechanical thrombectomy(MT) or both]. Baseline characteristics, in-hospital complications and 3-month outcomes were compared. The primary outcome was 3-month “favorable o utcome”, defined as modified Rankin Scale score 0...
Source: Internal and Emergency Medicine - April 3, 2020 Category: Emergency Medicine Source Type: research

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

Prospective assessment of patients with stroke in Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia
This study aimed to describe risk factors for stroke and clinical presentation of patients presenting to the emergency centre with stroke.MethodsWe conducted a cross sectional study conducted from August 2015 to January 2016 in an urban tertiary care centre in Addis Ababa, Ethiopia. Descriptive statistics and multivariable logistic regression models were used to evaluate associations between stroke types and stroke risk factors, and delayed presentation and clinical indicators. P-values less than .05 were considered statistically significant.ResultsA total of 104 patients were included. The mean age was 53 years, and 56%...
Source: African Journal of Emergency Medicine - July 10, 2018 Category: Emergency Medicine Source Type: research

Stroke Triage: EMS needs a diagnostic tool that goes beyond a simple history & physical exam
As a young EMT and paramedic, I had relatively little education about acute myocardial infarctions. In the age of the 3-lead ECG, education was largely focused on arrhythmia detection and how to differentiate heart blocks, tachycardia and bradycardia. Detection of heart attack was largely based upon history and physical exam findings. Three decades later, the thought of relying on a physical exam to diagnose a ST- elevation myocardial infarction (STEMI) is hard to imagine. Although we’ve made remarkable progress in the prehospital detection of STEMI, we’ve made significantly less progress in the diagnosis of acute stro...
Source: JEMS Patient Care - May 2, 2018 Category: Emergency Medicine Authors: Mark E.A. Escott, MD, MPH, FACEP, NRP Tags: Patient Care Columns Source Type: news

Blood Pressure Management Goals in Stroke Care
Blood pressure management goals in stroke care You arrive at a small rural emergency healthcare facility to transport a 72-year-old female who presents to the ED with the worst headache of her life. She’s to be transported to a tertiary center with neurosurgical services. Upon further questioning you determine her headache was sudden onset with maximum intensity. When reviewing her history and medications, you note that she’s currently on Coumadin (warfarin) with an international normalized ratio (INR) of 3.5, with the following vital signs noted on the monitor upon entering the room: blood pressure of 209/75 mmHg; hea...
Source: JEMS Patient Care - May 1, 2018 Category: Emergency Medicine Authors: Ken Davis, BA, EMT-P, FP-C Tags: Patient Care Cardiac & Resuscitation Source Type: news

Severe Symptoms, but a Truly Treatable Disease
​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Role of Thromboelastography Testing in the Emergency Medicine, Trauma Center, and Critical Care Environments
AbstractPurpose of ReviewThromboelastography (TEG) has been gaining attention for its potential use in a variety of disease of states to guide therapies and determine prognosis. This review will explore recent research specifically regarding the use of thromboelastography in the emergency, trauma, and critical care clinical environments.Recent FindingsThromboelastography has its drawbacks. TEG has wide operator and machine variability. Known coagulopathic states may exhibit normal viscoelastic results, indicating inconsistent results. Thromboelastography has shown to decrease transfusion of blood products in traumatic hemo...
Source: Current Emergency and Hospital Medicine Reports - February 15, 2018 Category: Emergency Medicine Source Type: research