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Differentiating contrast staining after acute ischemic stroke from hemorrhagic transformation during emergency evaluation
A hyperdense lesion observed in a computed tomographic (CT) image of the brain is usually suspected to be a hemorrhage during an emergency evaluation. Other rare differential diagnoses include contrast-induced encephalopathy (CIN) and acute cerebral infarction with contrast staining (CS). Recent contrast administration is a common risk factor for both CIN and CS. The former has been associated with favorable neurologic outcomes, whereas CS might have complications, such as hemorrhagic transformation (HT).
Source: The American Journal of Emergency Medicine - May 17, 2016 Category: Emergency Medicine Authors: Sing-Kong Ho, Jen-Kuang Lee, Yen-Jun Lai, Tzu-Chiao Lin, Cheng-Wei Liu Tags: Case Report Source Type: research

IV Thrombolysis in Very Severe and Severe Ischemic Stroke: Results from the SITS-ISTR Registry
Current European Medicine Agency guidelines do not recommend treatment of severe stroke with intravenous (IV) tPA (tissue plasminogen activator) due to concerns for increased risk of ICH (intracranial hemorrhage). This recommendation originated in 2003 around limited evidence.
Source: The Journal of Emergency Medicine - April 30, 2016 Category: Emergency Medicine Authors: Allison Ashley Harris Source Type: research

Analgesia in Neurocritical Care: An International Survey and Practice Audit*
Conclusions: Opiates and acetaminophen are preferred analgesic agents, and gabapentin is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.
Source: Critical Care Medicine - April 16, 2016 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

The Utility of Bolus IV Nicardipine for Hypertensive Emergencies in the Emergency Department
We describe the first two documented cases of use of nicardipine administered as an IV bolus dose in the emergency department for hypertensive emergencies involving acute ischemic stroke and hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - March 21, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report Source Type: research

The utility of bolus intravenous nicardipine for hypertensive emergencies in the ED
We describe the first 2 documented cases of use of nicardipine administered as an IV bolus dose in the emergency department (ED) for hypertensive emergencies involving acute ischemic stroke and hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - March 20, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report Source Type: research

Why switch from warfarin to NOACs?
Abstract Several patients with non-valvular atrial fibrillation treated with warfarin or other vitamin-K antagonists (VKA) might benefit from switching to an oral non vitamin-K antagonist anticoagulant (NOAC). In the absence of randomised comparative trials of switching to NOACs versus maintaining VKA treatment, several considerations argue in favour of a switching strategy. First, there is conclusive evidence that haemorrhagic strokes and intracranial bleedings are much fewer in number with NOACs than with warfarin. The risk of intracranial bleeding is 52 % lower with NOACS than with warfarin, with extremes rang...
Source: Internal and Emergency Medicine - March 14, 2016 Category: Emergency Medicine Source Type: research

Perceived Appropriateness of Shared Decision‐Making in the Emergency Department: A Survey Study
ConclusionsAcceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - January 25, 2016 Category: Emergency Medicine Authors: Marc A. Probst, Hemal K. Kanzaria, Dominick L. Frosch, Erik P. Hess, Gary Winkel, Ka Ming Ngai, Lynne D. Richardson Tags: Original Contribution Source Type: research

Perceived Appropriateness of Shared Decision-Making in the Emergency Department: A Survey Study.
CONCLUSIONS: Acceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective. This article is protected by copyright. All rights reserved. PMID: 26806170 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 25, 2016 Category: Emergency Medicine Authors: Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD Tags: Acad Emerg Med Source Type: research

Admission serum lactate predicts mortality in aneurysmal subarachnoid hemorrhage
Aneurysmal SAH is the most devastating form of hemorrhagic stroke. Primary predictors of mortality are based on initial clinical presentation. Initial serum lactic acid levels have been shown to predict mortality and disease severity. Initial serum lactate may be an objective predictor or mortality.
Source: The American Journal of Emergency Medicine - December 30, 2015 Category: Emergency Medicine Authors: Imo P. Aisiku, Peng Roc Chen, Hanh Truong, Daniel R. Monsivais, Jonathan Edlow Tags: Original Contribution Source Type: research

Pre-hospital emergency skills for medical students
Conclusion These results show that there is some anxiety amongst students about being able to manage pre-hospital emergencies in which the public might expect them to cope or in which they feel obliged to help. The results show that although students would be willing to help they may not posess the necessary knowledge to do so. They show that there is a demand for teaching focussed on these skills but that there is not necessarily a need for it taking into account the frequency of incidents encountered. A trial teaching programme will take place in July.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Wheeler, C. Tags: Stroke RCEM LIGHTNING PRESENTATIONS Source Type: research

Intracerebral Hemorrhage In Anticoagulated Patients: Evidence-Based Emergency Department Management (Stroke CME)
Spontaneous intracerebral hemorrhage is a true neurological emergency, and its management is made more complicated when patients are anticoagulated, as reversal of anticoagulation must be initiated simultaneously with diagnosis, treatment, and disposition.
Source: Emergency Medicine Practice - November 17, 2015 Category: Emergency Medicine 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

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury
Conclusions: HD +ESRD did not increase the post-HI risk of ICH. Therefore, it may not be necessary to lower the threshold of head CT in HD +ESRD patients.
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - October 28, 2015 Category: Emergency Medicine Authors: Hsin-Hung ChenChien-Chin HsuShih-Feng WengHung-Jung LinJhi-Joung WangHow-Ran GuoShih-Bin SuChien-Cheng HuangJiann-Hwa Chen Source Type: research

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