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Source: The American Journal of Emergency Medicine

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Total 186 results found since Jan 2013.

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding.
Source: The American Journal of Emergency Medicine - May 14, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn Source Type: research

Comparing Pleth variability index (PVI) variation induced by passive leg raising and Trendelenburg position in healthy volunteers
Hypovolemia, which is the main cause of circulatory failure in emergency medical settings, can often be managed by volume expansion [1]. However, the fluid responsiveness (FR) varies between the patients, and volume status of the patient can be evaluated by some predictors. Studies have demonstrated that static hemodynamic measurements (e.g., central venous pressure, mean arterial pressure) were of little value in discriminating between the patients who will or will not respond to volume expansion, and dynamic indices (e.g., arterial pressure wave form, stroke volume) were more accurate in evaluating volume status [1].
Source: The American Journal of Emergency Medicine - May 7, 2019 Category: Emergency Medicine Authors: Osman L ütfi Demirci, Gülşah Çıkrıkçı Işık, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research

Throwing it in reverse: An update on reversal of oral factor Xa inhibitors
In recent years, the use of oral Factor Xa (FXa) inhibitors such as rivaroxaban and apixaban, have seen more extensive utilization for stroke prevention in non-valvular atrial fibrillation and the prevention/treatment of venous thromboembolisms [1,2]. Some studies have shown a similar bleed risk between FXa inhibitors and warfarin while other studies demonstrated a decreased risk for a bleed with FXa inhibitors. Despite a possible decreased risk, the paucity of data available for treating an acute major bleed due to FXa inhibitors has led some clinicians to shy away from their use.
Source: The American Journal of Emergency Medicine - April 8, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Jacob A. Reeder, Mohammed A. Alkhalifah, David A. Moran, Michael A. Corvino Source Type: research

Sonographic diameter of optic nerve sheath in differentiation of ischemic and hemorrhagic strokes; a diagnostic accuracy study
Differentiating between ischemic and hemorrhagic types is of special importance in the treatment process of patients with stroke. The present study was designed with the aim of evaluating the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) in differentiation of ischemic from hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - August 17, 2018 Category: Emergency Medicine Authors: Mohammad Manouchehrifar, Masoumeh Lakestani, Parvin Kaskani, Saeed Safari Source Type: research

Paradoxical brain embolism shadowing massive pulmonary embolism
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagn...
Source: The American Journal of Emergency Medicine - May 15, 2018 Category: Emergency Medicine Authors: Fran çois Bagate, Alexandre Bedet, Armand Mekontso Dessap, Guillaume Carteaux Source Type: research

Acute aortic occlusion in a patient without risk factors
A 94-year-old female with a history of ischemic stroke, mild right hemiparesis, vascular dementia, breast cancer with right mastectomy, colon cancer resulting in colectomy, hyperlipidemia, and hypertension presented to the emergency department (ED) with bilateral leg pain. Patient had no smoking history, and her medications included Donepezil, Aspirin, Citalopram, Losartan, and Pantoprazole.
Source: The American Journal of Emergency Medicine - March 28, 2018 Category: Emergency Medicine Authors: Trina Stoneham, Erin L. Simon Source Type: research

Retrospective assessment of succinylcholine use in acute stroke care: What are the risks?
Dear Sir,
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jenna Fancher, Gregory Meola, William Paolo, Robert Seabury Source Type: research

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes
Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients.
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jon W. Schrock, Linda Lou, Benjamin A.W. Ball, J. Van Etten Source Type: research

Retrospective assessment of succinylcholine use in acute stroke care: What are the risks?
Dear Sir,
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jenna Fancher, Gregory Meola, William Paolo, Robert Seabury Source Type: research

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes
Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients.
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jon W. Schrock, Linda Lou, Benjamin A.W. Ball, J. Van Etten Source Type: research

Icatibant for the treatment of orolingual angioedema following the administration of tissue plasminogen activator
Angioedema is swelling of the dermis and mucosal tissues caused by hyper permeability of post capillary venules due to the release of vasodilators such as histamine and bradykinin. It is a rare, but potentially life-threatening side effect of alteplase with a reported incidence of 0.9 –5.1% in ischemic stroke patients [1,2]. Alteplase is a recombinant tissue plasminogen activator (rt-PA) that works by binding to fibrin in a blood clot, and subsequently converting plasminogen to plasmin which initiates fibrinolysis [3].
Source: The American Journal of Emergency Medicine - March 12, 2018 Category: Emergency Medicine Authors: Emily Brown, Christina Campana, Jacob Zimmerman, Steven Brooks Source Type: research

Emergency medicine considerations in atrial fibrillation
Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia.
Source: The American Journal of Emergency Medicine - February 2, 2018 Category: Emergency Medicine Authors: Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R. Warix Source Type: research

Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department
Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence.
Source: The American Journal of Emergency Medicine - December 28, 2017 Category: Emergency Medicine Authors: Stacy A. Trent, Michael A. Johnson, Erica A. Morse, Edward P. Havranek, Jason S. Haukoos Source Type: research

The effect of ethyl pyruvate and N-acetylcysteine on ischemia-reperfusion injury in an experimental model of ischemic stroke
Reperfusion therapies play an important role in early-period treatment for patients presenting to the emergency department due to stroke. However, the ischemia-reperfusion injury that may occur with reperfusion must then be considered. The purpose of this study was to determine the effectiveness of N-acetylcysteine (NAC) and ethyl pyruvate in preventing ischemia-reperfusion injury.
Source: The American Journal of Emergency Medicine - June 5, 2016 Category: Emergency Medicine Authors: Suha Turkmen, Ozgen Cekic Gonenc, Yunus Karaca, Ahmet Mentese, Selim Demir, Ercument Beyhun, Aynur Sahin, Abdulkadir Gunduz, Esin Yulug, Suleyman Turedi Source Type: research

The Effect of Ethyl Pyruvate and N-Acetylcysteine on Ischemia Reperfusion Injury in an Experimental Model of Ischemic Stroke
Reperfusion therapies play an important role in early-period treatment of patients presenting to the emergency department due to stroke. However, the ischemia–reperfusion injury that may occur with reperfusion must then be considered. The purpose of this study was to determine the effectiveness of N-acetylcysteine (NAC) and ethyl pyruvate in preventing ischemia–reperfusion injury.
Source: The American Journal of Emergency Medicine - June 5, 2016 Category: Emergency Medicine Authors: Turkmen Suha, Cekic Gonenc Ozgen, Karaca Yunus, Mentese Ahmet, Demir Selim, Beyhun Ercument, Sahin Aynur, Gunduz Abdulkadir, Yulug Esin, Turedi Suleyman Source Type: research

Fatal hemopericardium after intravenous recombinant transplasminogeen activator (rt-PA) for acute ischemic stroke
Intravenous recombinant transplasminogeen activator (rt-PA) treatment is considered as standard acute phase treatment in ischemic stroke. In the initial stroke guidelines, recent myocardial infarction (MI) was listed as a contraindication for rt-PA treatment due to the increased risk of myocardial wall rupture. However, in the recent American Heart Association/American Stroke Association guideline, it is regarded only as a relative contraindication, and in the European guidelines, currently it is not listed as a contraindication.
Source: The American Journal of Emergency Medicine - May 27, 2016 Category: Emergency Medicine Authors: Hanna Hensen, Fianne Spaander, Matthijs Bax, Hille Koppen Tags: Case Reports Source Type: research

Stroke prevention for patients with atrial fibrillation: values and preferences of Canadian emergency medicine trainees
Atrial fibrillation (AF) is the most common serious cardiac arrhythmia, and it is associated with a 5-fold increase in the risk of ischemic stroke [1 –3] . This risk can be reduced by up to 64% with oral anticoagulation (OAC) [4] . Many patients are first diagnosed with AF in the context of visit to the emergency department (ED), and AF can account for 1% or more of ED visits [5–7] . Clinical risk stratification for stroke and bleeding and subsequent prescription of OAC are the cornerstones of management of AF.
Source: The American Journal of Emergency Medicine - May 13, 2016 Category: Emergency Medicine Authors: William F. McIntyre, Zardasht Oqab, Payam Yazdan-Ashoori, Kieran L. Quinn, Erik M. van Oosten, Wilma M. Hopman, Adrian Baranchuk Tags: Correspondence Source Type: research

Stroke Prevention for Patients with Atrial Fibrillation: Values and Preferences of Canadian Emergency Medicine Trainees
Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and it is associated with a five-fold increase in the risk of ischemic stroke[1–3]. This risk can be reduced by up to 64% with oral anticoagulation (OAC)[4]. Many patients are first diagnosed with atrial fibrillation (AF) in the context of visit to the emergency department (ED) and AF can account for 1% or more of ED visits[5–7]. Clinical risk stratification for stroke and bleeding and subsequent prescription of OAC are the cornerstones of management of AF.
Source: The American Journal of Emergency Medicine - May 13, 2016 Category: Emergency Medicine Authors: William F. McIntyre, Zardasht Oqab, Payam Yazdan-Ashoori, Kieran L. Quinn, Erik M. van Oosten, Wilma M. Hopman, Adrian Baranchuk Tags: Correspondence Source Type: research

Is it dangerous to treat acute ischemic stroke by thrombolytic therapy in patients with comorbid intracranial aneurysms
The safety of cerebral ischemic stroke patients with comorbid intracranial aneurysms treated by thrombolysis is still an unsolved mystery. We aimed to perform a secondary analysis and review to provide evidence on whether stroke patients with intracranial aneurysms have worse outcomes following thrombolysis.
Source: The American Journal of Emergency Medicine - December 16, 2015 Category: Emergency Medicine Authors: Jiayue Ding, Jie Han, Zhe Jing, Yue Jiang Source Type: research

When stroke is more than stroke
We describe a case of aortic dissection presenting as right middle cerebral artery syndrome who received intravenous thrombolysis complicated by aortic rupture with a fatal outcome. A Medline search shows that this is the first report of aortic rupture since the inception of thrombolysis for acute stroke.
Source: The American Journal of Emergency Medicine - November 18, 2015 Category: Emergency Medicine Authors: Shing Ching, Soo Moi Ting Tags: Case Report Source Type: research

Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging)
Imaging in acute stroke has traditionally focussed on the 4Ps—parenchyma, pipes, perfusion, and penumbra—and has increasingly relied upon advanced techniques including magnetic resonance imaging to evaluate such patients. However, as per European Magnetic Resonance Forum estimates, the availability of magnetic resonance imaging scanners for the general population in India (0.5 per million inhabitants) is quite low as compared to Europe (11 per million) and United States (35 per million), with most of them only present in urban cities.
Source: The American Journal of Emergency Medicine - November 3, 2015 Category: Emergency Medicine Authors: Shriram Varadharajan, Jitender Saini, Ullas V. Acharya, Arun Kumar Gupta Tags: Brief Report Source Type: research

CT Angiography in acute stroke (Revisiting the 4Ps of Imaging)
Imaging in acute stroke has traditionally focussed on the 4 Ps - Parenchyma, Pipes, Perfusion and Penumbra and has increasingly relied upon advanced techniques including Magnetic Resonance Imaging (MRI) to evaluate such patients. However as per European Magnetic Resonance Forum (EMRF) estimates, the availability of MRI scanners for the general population in India (0.5 per million inhabitants) is quite low as compared to Europe (11 per million) and USA (35 per million), with the vast majority of them only present in urban cities.
Source: The American Journal of Emergency Medicine - November 3, 2015 Category: Emergency Medicine Authors: Shriram Varadharajan, Jitender Saini, Ullas VA, Arun Kumar Gupta Source Type: research

Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED
Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rcso2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
Source: The American Journal of Emergency Medicine - July 22, 2015 Category: Emergency Medicine Authors: Thomas J. Abramo, Z. Leah Harris, Mark Meredith, Kristen Crossman, Rawle Seupaul, Abby Williams, Sheila McMorrow, Jennifer Dindo, Angela Gordon, Maria Melguizo-Castro, Zhuopei Hu, Todd Nick Tags: Original Contribution Source Type: research

Pre-procedure Change in Arterial Occlusion in Acute Ischemic Stroke Patients undergoing Endovascular Treatment by CT Angiography
The American Heart Association/American Stroke Association guidelines strongly recommend a noninvasive intracranial vascular study such as CT angiogram in acute stroke patient if endovascular treatment is contemplated.
Source: The American Journal of Emergency Medicine - February 4, 2015 Category: Emergency Medicine Authors: Adnan I. Qureshi, Mushtaq H. Qureshi, Farhan Siddiq, Daraspreet Kainth, Ameer E. Hassan, Alberto Maud Tags: Original Contribution Source Type: research

Preprocedure change in arterial occlusion in acute ischemic stroke patients undergoing endovascular treatment by computed tomographic angiography
The American Heart Association/American Stroke Association guidelines strongly recommend a noninvasive intracranial vascular study such as computed tomographic (CT) angiogram in acute stroke patient if endovascular treatment is contemplated.
Source: The American Journal of Emergency Medicine - February 4, 2015 Category: Emergency Medicine Authors: Adnan I. Qureshi, Mushtaq H. Qureshi, Farhan Siddiq, Daraspreet Kainth, Ameer E. Hassan, Alberto Maud Tags: Original Contribution Source Type: research

Association of plasma diamine oxidase and intestinal fatty acid–binding protein with severity of disease in patient with heat stroke
The aim of this study was to describe the role of intestinal fatty acid–binding protein (iFABP) and allergy-related diamine oxidase (DAO) in patients with heat stroke (HS).
Source: The American Journal of Emergency Medicine - February 2, 2015 Category: Emergency Medicine Authors: Lin Zhang, Xiaoming Fan, Zhiyue Zhong, Guoxiong Xu, Jie Shen Tags: Original Contribution Source Type: research

Ischemic Stroke Differential Diagnose: Spontaneous Spinal Epidural Hematoma can be fatal
Spontaneous Spinal Epidural Hematoma (SSEH) is rarely seen, it is the important reason for the spinal cord compression. Patients generally visit the doctor due to the acute pain in the neck and interscapular area. The male patient 58years old was admitted to the emergency service of our hospital with the sudden onset neck pain and followed by rapidly right hemiparesis He arrived at our hospital 120minutes after the onset of her symptoms with suspected acute stroke. We assessed for acute stroke performed clinical examinations necessary for intravenous thrombolytic treatment with alteplase, No abnormality was observed in his...
Source: The American Journal of Emergency Medicine - January 21, 2015 Category: Emergency Medicine Authors: Huseyin Buyukgol, M. Kemal Ilik, Faik Ilik Source Type: research

Validation of the Use of BNP POCT platform in Preliminary Recognition of Cardioembolic Stroke Patients In the ED
To validation of the use of plasma B-type natriuretic peptide(BNP) Point of Care Test (POCT) platform in preliminary recognition of cardioembolic stroke patients in the Emergency Department(ED).
Source: The American Journal of Emergency Medicine - January 16, 2015 Category: Emergency Medicine Authors: Wu Zhixin, Zhao Mingming, He Mingfeng, Zeng Hongke, Tan Feng, Li Kuangyi, Chen Shenglong, Han Qianpeng, Wang Qiaosheng Source Type: research

Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED
The aim of the study is to validate of the use of plasma B-type natriuretic peptide (BNP) point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the emergency department (ED).
Source: The American Journal of Emergency Medicine - January 16, 2015 Category: Emergency Medicine Authors: Zhixin Wu, Mingming Zhao, Mingfeng He, Hongke Zeng, Feng Tan, Kuangyi Li, Shenglong Chen, Qianpeng Han, Qiaosheng Wang Tags: Original Contribution Source Type: research

Acute Vertebrobasilar Ischemic Stroke Due To Electric Injury
Electrical injuries are most commonly due to household accidents. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current and duration of contact with the body. Various types of neurological damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellar ataxia, hypoxic encephalopathy and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury.
Source: The American Journal of Emergency Medicine - January 6, 2015 Category: Emergency Medicine Authors: Rajendra Singh Jain, Sunil Kumar, Desai Tushar Suresh, Rakesh Agarwal Tags: Case Report Source Type: research

Diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE-1) in an experimental model of acute ischemic stroke
Considering the critical role of early action in management of stroke, there is still a need for a biomarker that would reliably assist in the early diagnosis and patient selection for tissue plasminogen activator (t-PA) therapy, which has provided a considerable success in terms of mortality and morbidity of patients with stroke. This is particularly important if this novel biochemical marker that could give rapid results, specific for brain damage and that can be used in the emergency setting for early diagnosis and differentiation from other conditions that mimics some stroke findings [1,2].
Source: The American Journal of Emergency Medicine - December 2, 2014 Category: Emergency Medicine Authors: Turkmen Suha, Eryigit Umut, Karaca Yunus, Mentese Ahmet, Uzun Sumer Aysegul, Yulug Esin, Aksut Nurhak, Gazioglu Sibel, Gunduz Abdulkadir Tags: Original Contribution Source Type: research

Hydration therapy: critical intervention in the ED to prevent stroke in evolution after acute ischemic stroke
We read the original article by Lin et al [1] with great enthusiasm. The authors have revealed the role of simple hydration therapy to prevent stroke in evolution (SIE) after acute ischemic stroke (AIS), which was done according to World Health Organization hydration protocol 2005 for diarrhea. They have concluded that providing hydration therapy to patients who present with a blood urea nitrogen/creatinine (BUN/Cr) ratio greater than or equal to 15 after ischemic stroke may help prevent the development of SIE, and such prevention is likely to improve prognosis given that SIE is a key indicator of poor prognosis after stroke.
Source: The American Journal of Emergency Medicine - September 25, 2014 Category: Emergency Medicine Authors: Meera Ekka, Sashi Bhusan Lakra, Praveen Aggarwal, Nayer Jamshed Tags: Correspondence Source Type: research

Prevention of emergency physician migratory contamination in a cluster randomized trial to increase tissue plasminogen activator use in stroke (the INSTINCT trial)
Cluster randomized trials (CRTs) are increasingly used to evaluate quality improvement interventions aimed at health care providers. In trials testing emergency department (ED) interventions, migration of emergency physicians (EPs) between hospitals is an important concern, as contamination may affect both internal and external validity. We hypothesized that geographically isolating EDs would prevent migratory contamination in a CRT designed to increase ED delivery of tissue plasminogen activator (tPA) in stroke (the INSTINCT trial).
Source: The American Journal of Emergency Medicine - September 6, 2014 Category: Emergency Medicine Authors: Victoria C. Weston, William J. Meurer, Shirley M. Frederiksen, Allison K. Fox, Phillip A. Scott Tags: Research Seminar Source Type: research

Intramural hematoma of the esophagus after thrombolysis for ischemic stroke
We report the case of an 88-year-old woman who developed an intramural hematoma of the esophagus after intravenous thrombolysis for an acute ischemic stroke. Before thrombolysis, nasogastric intubation was attempted unsuccessfully. She was kept on nil by mouth, intravenous hydration, proton pump inhibitor, antiemetics, and an antibiotic initiated 2 days before for periodontal disease.
Source: The American Journal of Emergency Medicine - August 29, 2014 Category: Emergency Medicine Authors: Mario Jorge Silva, Joana Saiote, Vera Salvado, Ana Paiva Nunes, Pedro Duarte Tags: Case report Source Type: research

Nonconvulsive status epilepticus masquerading as stroke
This case describes a patient with multiple stroke risk factors—including prior stroke—who presented to the emergency department with symptoms suggestive of stroke and who received a rapid stroke work up but was later found to be in nonconvulsive status epilepticus (NCSE). This case report highlights the challenge and importance of making an accurate diagnosis in NCSE, and we have included teaching points to help clinicians understand the clinical manifestations and diagnosis of NCSE as well as how it may impact a patient's prognosis.
Source: The American Journal of Emergency Medicine - August 28, 2014 Category: Emergency Medicine Authors: Christopher Kennel, Andreas Michas-Martin, Brian D. Berman, Sharon Poisson Tags: Case Report Source Type: research

Spontaneous splenic rupture after thrombolysis for ischemic stroke
We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Rachid Sirbou, Cindy Tissier, Yannick Bejot, Marc Freysz Tags: Case Report Source Type: research

Simultaneous event of brachial artery occlusion and acute embolic stroke
Although the rapid and accurate diagnosis of both acute ischemic stroke and extremity ischemia is essential to the timely and appropriate treatment, it is not always easy to differentiate between true stroke and stroke mimics. Although in general, limb ischemia due to extremity embolism is not included in stroke mimics or misdiagnosis, limb arterial embolism should be considered in the differential diagnosis of acute monoparesis because the diagnosis may be missed if the other typical manifestations of this presentation (pain, pallor, pulselessness, sensory loss, and coolness of the arm) are overlooked.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Soo Hoon Lee, Nack-Cheon Choi, In Seok Jang, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Dong Seob Kim Tags: Case Report Source Type: research

Factors associated with delayed evaluation of patients with potential stroke in US EDs
The American Heart Association/American Stroke Association guidelines recommend all patients presenting to emergency departments (EDs) with a potential stroke be seen within 10 minutes of arrival, although this may not be achieved in all patients. We sought to identify factors associated with delayed evaluation of ED patients with potential stroke.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Jonathan Taylor, Ken Uchino, M. Shazam Hussain, Jestin N. Carlson Tags: Original Contribution Source Type: research

ED volume and functional status after acute ischemic stroke
Acute ischemic stroke (AIS) is a time-sensitive disease where rapid identification and treatment are critical [1-6]. Increased emergency department (ED) volume has been implicated in poor patient outcomes in other time-sensitive diagnoses [7-11]. Given that most of AIS care is provided at nontertiary care centers, it is important to understand the impact of ED process metrics in the community setting [12]. We sought to evaluate the impact of daily ED volumes on outcomes of patients with AIS in a community hospital.
Source: The American Journal of Emergency Medicine - August 22, 2014 Category: Emergency Medicine Authors: Stephanie Larson, Ken Uchino, Nicole Joseph, Jestin N. Carlson Tags: Correspondence Source Type: research

Drill down analysis of door-to-needle time of acute ischemic stroke patients treated with intravenous tissue plasminogen activator
Target stroke guidelines recommend a door-to-needle time of ≤60 minutes for acute ischemic stroke (AIS) patients treated with intravenous (IV) tissue-type plasminogen activator (tPA). We sought to analyze all diagnostic steps involved in the acute evaluation and treatment of AIS with IV tPA and to look for causes of delay in door to needle time (DNT).
Source: The American Journal of Emergency Medicine - August 7, 2014 Category: Emergency Medicine Authors: Jon W. Schrock, Marija Lum Tags: Original Contribution Source Type: research

Re-administration of Intravenous Alteplase in Acute Ischemic Stroke Patients: Case Series and Systematic Review
Background: Due to a high risk of recurrence of ischemic events, some patients may be candidates for re-administration of intravenous (IV) alteplase. Methods: We performed a single center review and performed a search on PubMed from January 1966 to April 2014 for cases of re-administration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0-2 at discharge or at 1-3 months, improvement of ≥4 points within 24 hours in the National Institutes of Health Stroke Scale (NIHSS) score, or as a major improvement in the 72-hour NIHSS score.
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Adnan I. Qureshi, Ahmed A. Malik, Melissa Freese, Michelle Thompson, Asif A. Khan, M. Fareed K. Suri Source Type: research

Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review
Background: Because of a high risk of recurrence of ischemic events, some patients may be candidates for readministration of intravenous (IV) alteplase. Methods: We performed a single-center review and performed a search on PubMed from January 1966 to April 2014 for cases of readministration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0 to 2 at discharge or at 1 to 3 months, improvement of greater than or equal to 4 points within 24 hours in the National Institutes of Health Stroke Scale score, or as a major improvement in the 72-hour National Institutes of Health Stroke Scale score.
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Adnan I. Qureshi, Ahmed A. Malik, Melissa Freese, Michelle J. Thompson, Asif A. Khan, M. Fareed K. Suri Tags: Case Report Source Type: research

Successful management of heat stroke associated with multiple-organ dysfunction by active intravascular cooling
We report successful cooling with initial intravascular cooling use that rapidly achieved the target temperature with continued normothermia thereafter.
Source: The American Journal of Emergency Medicine - June 12, 2014 Category: Emergency Medicine Authors: Hideyuki Hamaya, Toru Hifumi, Kenya Kawakita, Tomoya Okazaki, Kazutaka Kiridume, Natsuyo Shinohara, Yuko Abe, Koshiro Takano, Masanobu Hagiike, Yasuhiro Kuroda Tags: Case Report Source Type: research

Acute pediatric stroke—what’s the hurry? A case for emergency physician-performed echocardiography
We describe a case of acute ischemic stroke for which emergent, physician-sonographer–performed transthoracic echocardiography (TTE) changed his outcome. The patient in this case presented with left-sided hemiparesis, with subsequent CT Angiography (CTA) imaging and follow-on neurosurgical embolectomy for a proximal middle cerebral artery occlusion after which showed early recovery of muscular deficit.
Source: The American Journal of Emergency Medicine - April 18, 2014 Category: Emergency Medicine Authors: Christopher D. Thom, Scott E. Sparks Tags: Case Report Source Type: research

Good outcome after intravenous thrombolysis for acute stroke in a patient under treatment with dabigatran
We describe an unusual case of treatment IV rt-PA for acute ischemic stroke in a patient receiving dabigatran for AF.
Source: The American Journal of Emergency Medicine - April 18, 2014 Category: Emergency Medicine Authors: Cátia Diogo, Josiana Duarte, Sofia Sobral, Paula Pestana, Hipólito Nzwalo, Henrique Rita, José Sousa e Costa Tags: Case Report Source Type: research