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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. Methods We 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. Results A total of 104 patients were included. The mean age was 53 years, and...
Source: African Journal of Emergency Medicine - December 16, 2017 Category: Emergency Medicine Source Type: research

Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database
Objectives: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. Design: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry. Setting: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015. Patients: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Interventions: None. Measurements and Main Results: We included 4,988 adults supporte...
Source: Critical Care Medicine - July 15, 2017 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity
Prior stroke research has confirmed that early, therapeutic intervention is crucial to improve outcomes in acute cerebrovascular disease (ACVD) including both acute ischemic stroke and intracerebral hemorrhage. Neurological deficit status in the field is crucial to hospital pre-arrival notification, routing to stroke centers, and for initiation of experimental, pre-hospital treatment interventions. The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital and emergency department (ED) use.
Source: The Journal of Emergency Medicine - May 1, 2017 Category: Emergency Medicine Authors: Katherine C. Wurlitzer Tags: Abstract Source Type: research

Pre-hospital ct diagnosis of subarachnoid hemorrhage
Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent ass...
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - February 28, 2017 Category: Emergency Medicine Authors: Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch and Christian Georg Lund Source Type: research

Predictors of in-hospital mortality and dependence at discharge in patients with MCA stroke with intravenous thrombolysis
AbstractEarly risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and...
Source: Internal and Emergency Medicine - December 26, 2016 Category: Emergency Medicine Source Type: research

Diagnosis and Management of Acute Intracerebral Hemorrhage
This article provides an updated review on ICH diagnosis and management in the emergency department.
Source: Emergency Medicine Clinics of North America - September 2, 2016 Category: Emergency Medicine Authors: Andrea Morotti, Joshua N. Goldstein Source Type: research

Prehospital Systolic Blood Pressure is Higher in Acute Stroke Compared with Stroke Mimics
Elevated blood pressure (BP) in patients with acute stroke is common and associated with poor outcomes. Previous, limited data suggests that acute BP reduction improves outcomes after intracerebral hemorrhage (ICH). Recent pilot studies have suggested pre-hospital BP lowering strategies but at this point pre-hospital blood pressure in patients with acute stroke are poorly understood.
Source: The Journal of Emergency Medicine - August 31, 2016 Category: Emergency Medicine Authors: Katherine Wurlitzer Source Type: research

Patient characteristics affecting stroke identification by emergency medical service providers in Brooklyn, New York
This study aims to identify patient characteristics that affect prehospital identification of stroke by Long Island college hospital (LICH) emergency medical services (EMS). All suspected strokes brought to LICH by LICH ambulances from January 1, 2010 to December 31, 2011 were included in the study. We compared prehospital care report-based diagnosis against the get with the guidelines (GWTG) database. Age-adjusted logistic regression models were used to study that the effect of individual patient characteristics have on EMS providers’ diagnosis. Included in the study were 10,384 patients with mean age 43.9 years. Of wh...
Source: Internal and Emergency Medicine - November 9, 2015 Category: Emergency Medicine Source Type: research

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center
Abstract Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mor...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2015 Category: Emergency Medicine Source Type: research

Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tPA for Acute Ischemic Stroke. Darger, Bryan; Gonzales, Nicole R.; Banuelos, Rosa C.; Radecki, Ryan P.; Peng, Hui; Doshi, Pratik B.
Introduction: The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. Methods: We performed a retrospective review of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) between 2004-2011. We compared the outcomes of patients treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined b...
Source: Western Journal of Emergency Medicine - January 1, 2015 Category: Emergency Medicine Source Type: research

Gyral Calcification in an Adult Masquerading as Subarachnoid Hemorrhage
An 85-year-old female with a medical history significant for coronary artery disease, status post pacemaker placement, and a prior stroke presented to an outside emergency department (ED) with complaints of lethargy, diaphoresis, dysarthria, and an episode of transient loss of consciousness at her nursing home. There was no history of trauma and she was not on any anticoagulants. A computed tomography (CT) scan was performed and read by the ED physician as subarachnoid hemorrhage (SAH) in the left sylvian fissure, and the patient was emergently transferred to our hospital for further management with a tentative diagnosis of SAH.
Source: The Journal of Emergency Medicine - November 5, 2014 Category: Emergency Medicine Authors: Jacquelyn A. Corley, Manish K. Kasliwal, Roham Moftakhar Tags: Visual Diagnosis in Emergency Medicine Source Type: research

The Case Files: Unusual Headache
By Al-Hashimi, Siddhartha DO; Leavens, John MD A 23-year-old woman with a history of migraine headaches presented to the emergency department for a different-than-usual headache. She had a six-day history of intermittent headaches. The onset was at rest, and there was no history of trauma.   The headache was located behind her left eye, and it radiated into the posterior portion of her head. She characterized it as being 8/10 in intensity. Bright lights were reported as an exacerbating factor. The headache was associated with nausea and multiple episodes of emesis. She had 10 episodes of vomiting the evening prior to arri...
Source: The Case Files - June 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Case studies in prehospital care from London HEMS: pre-hospital administration of prothrombin complex concentrate to the head-injured patient
A case of pre-hospital administration of prothrombin complex concentrate to a patient anticoagulated with warfarin and with suspected intracranial haemorrhage is described. Effective, early reversal of anticoagulation by the time of arrival at hospital was achieved.
Source: Emergency Medicine Journal - February 13, 2013 Category: Emergency Medicine Authors: Lendrum, R. A., Kotze, J.-P., Lockey, D. J., Weaver, A. E. Tags: Drugs: cardiovascular system, Stroke Cases from hems Source Type: research

Systemic thrombolysis for stroke in pregnancy
Pregnancy is an exclusion criterion for all clinical trials that validate alteplase in acute stroke, so our knowledge about its use in this condition is relative only to case reports and case series. Herein, we report the successful use of intravenous recombinant tissue-type plasminogen activator (rt-PA) in pregnant women with acute stroke. The patient was a 28-year-old who was 16 weeks pregnant. She presented to our hospital 1 hour after a sudden onset of mothor aphasia, hemiparesis, and hypoesthesia on the right side due to incipient ischemia in the left cerebral hemisphere resulting from ipsilateral middle cerebral arte...
Source: The American Journal of Emergency Medicine - August 6, 2012 Category: Emergency Medicine Authors: Rossana Tassi, Maurizio Acampa, Giovanna Marotta, Samuele Cioni, Francesca Guideri, Simone Rossi, Alfonso Cerase, Giuseppe Martini Tags: Case Reports Source Type: research

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