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Carotid Artery Dissection With Associated Territory Stroke After a Minor Head Trauma in a Healthy 4-Month-Old Child
In conclusion, hyperextension and/or hyperrotation in minor head trauma is a possible pathomechanism for ICA dissection in infants. However, the scenario is extremely rare, and to our best knowledge, this is the first report describing it. In our patient, anticoagulation did not worsen hemorrhagic transformation.
Source: Pediatric Emergency Care - December 1, 2017 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Blood Biomarkers for the Early Diagnosis of Stroke
Stroke diagnosis can be a challenging process during the acute phase, however, if done quickly and effectively, early tPA (tissue-type plasminogen activator) administration has been shown to significantly reduce associated morbidity and mortality. Despite its benefits, tPA administration is often delayed secondary to limitations in diagnosis of stroke mimics or in differentiating ischemic versus hemorrhagic strokes.
Source: The Journal of Emergency Medicine - November 29, 2017 Category: Emergency Medicine Authors: Heather Roesly Tags: Abstract Source Type: research

Emergency Coagulation Assessment During Treatment with Direct Oral Anticoagulants
Direct oral anticoagulants (DOACs) have become more frequently utilized for conditions requiring long-term anticoagulation, largely owing to the ease of fixed dosing and lack of required routine coagulation monitoring. However, there is limited availability of specific coagulation tests for DOACs, which complicates treatment decisions for emergencies such as ischemic or hemorrhagic stroke requiring thrombolysis or surgical intervention. Much controversy has surrounded the adequacy of global coagulation tests in evaluating DOAC induced anticoagulation.
Source: The Journal of Emergency Medicine - November 29, 2017 Category: Emergency Medicine Authors: Krysia Crabtree Tags: Abstract Source Type: research

Racial Differences in Palliative Care Use After Stroke in Majority-White, Minority-Serving, and Racially Integrated U.S. Hospitals
Conclusions: The odds of receiving palliative care for both white and minority stroke patients is lower in minority compared with white hospitals, suggesting system-level factors as a major contributor to explain race disparities in palliative care use after stroke.
Source: Critical Care Medicine - November 18, 2017 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Management of Major Vascular Injuries
Vascular injuries represent a significant burden of mortality and disability. Blunt injuries to the neck vessels can present with signs of stroke either immediately or in a delayed fashion. Most injuries are detected with computed tomography angiography and managed with either antiplatelet medications or anticoagulation. In contrast, patients with penetrating injuries to the neck vessels require airway management, hemorrhage control, and damage control resuscitation before surgical repair. The keys to diagnosis and management of peripheral vascular injury include early recognition of the injury; hemorrhage control with dir...
Source: Emergency Medicine Clinics of North America - November 11, 2017 Category: Emergency Medicine Authors: Chris Evans, Tim Chaplin, David Zelt Source Type: research

Neurology Concepts: Young Women and Ischemic Stroke —Evaluation and Management in the Emergency Department
ConclusionUnique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
Source: Academic Emergency Medicine - October 10, 2017 Category: Emergency Medicine Authors: Bernard P. Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E. Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen Tags: Original Contribution Source Type: research

Rupture of an Occult Intracranial Mycotic Aneurysm after Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke
We present a case of a stroke patient who was an appropriate candidate and was treated with rtPA who experienced a fatal subarachnoid hemorrhage due to a ruptured mycotic aneurysm (MA).
Source: The Journal of Emergency Medicine - October 6, 2017 Category: Emergency Medicine Authors: Jared Glenn, Margaret Strecker-McGraw, Ian McGraw, Karim Jabbar, Nathan A. James, C. Keith Stone Tags: Selected Topics: Neurological Emergencies Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Tags: Case Report Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Case report of an intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Source Type: research

Systemic Thrombolysis, Catheter ‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis
ConclusionIn our model, for those eligible, CDT results in the largest number of QALYs for patients with intermediate‐risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality‐of‐life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results.
Source: Academic Emergency Medicine - September 13, 2017 Category: Emergency Medicine Authors: Christopher Kabrhel, Ayman Ali, Jin G. Choi, Chin Hur Tags: Original Contribution Source Type: research

The clinical profile of patients with cardiac arrest induced by hemorrhagic stroke
Source: Resuscitation - September 9, 2017 Category: Emergency Medicine Authors: Hiroki Nagasawa, Kouhei Ishikawa, Ikuto Takeuchi, Kei Jitsuiki, Takashi Iso, Akihiko Kondo, Hiromichi Ohsaka, Kazuhiko Omori, Youichi Yanagawa Tags: Letter to the Editor Source Type: research

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis
This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes.
Source: The American Journal of Emergency Medicine - August 19, 2017 Category: Emergency Medicine Authors: Truman J. Milling, Carol L. Clark, Charles Feronti, Shlee S. Song, Sam S. Torbati, Gregory J. Fermann, Jeffrey Weiss, Dony Patel Source Type: research

Impact of Moderate Hyperchloremia on Clinical Outcomes in Intracerebral Hemorrhage Patients Treated With Continuous Infusion Hypertonic Saline: A Pilot Study
Conclusions: We observed higher rates of in-hospital mortality in patients who developed moderate hyperchloremia during treatment with continuous IV infusion 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality. These results suggest that chloride values should be monitored closely during hypertonic saline treatment as moderate elevations may impact outcomes in intracerebral hemorrhage patients.
Source: Critical Care Medicine - August 17, 2017 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Oklahoma EMT Association Hosts Annual Meeting
Last week, the Oklahoma EMT Association hosted its annual meeting in Norman, Oklahoma. JenaLu Simpson, OEMTA President kicked off the conference on Wednesday morning by introducing OSDH EMS Director, Dale Adkerson for the State of EMS Address.  Many sessions are offered throughout the week ranging from trauma casualty, cerebral hemorrhage and EMS, infection control, Stop the Bleed, STEMI and many more. A few highlights from day one included a representative from OU Medical Clinic, who spoke on the important role of EMS in human trafficking. EMS professionals were encouraged to do things differently if they suspect a ...
Source: JEMS Administration and Leadership - August 1, 2017 Category: Emergency Medicine Authors: JEMS Staff Tags: News Administration and Leadership Source Type: news

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