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Factors associated with use of emergency medical services in patients with acute stroke
Abstract: Purposes: The aim of this study was to investigate the factors associated with use of emergency medical services (EMS) in patients with acute stroke.Methods: Prospective data on consecutive patients with acute stroke who presented to the emergency department of a university medical center from January 1, 2010, to July 31, 2011, were analyzed. Patients were excluded if they had an unknown residence, had onset of stroke at a nursing home or hospital, or were transferred from another hospital. Variables for all patients with stroke and ischemic stroke who did and did not use EMS were compared.Results: In total, 1344...
Source: The American Journal of Emergency Medicine - March 4, 2013 Category: Emergency Medicine Authors: Nai-Chuan Chen, Ming-Ju Hsieh, Sung-Chun Tang, Wen-Chu Chiang, Kuang-Yu Huang, Li-Kai Tsai, Patrick Chow-In Ko, Matthew Huei-Ming Ma, Jiann-Shing Jeng Tags: Original Contributions Source Type: research

Prehospital stroke diagnosis and treatment in ambulances and helicopters—a concept paper
Abstract: Stroke is the second common cause of death and the primary cause of early invalidity worldwide. Different from other diseases is the time sensitivity related to stroke. In case of an ischemic event occluding a brain artery, 2000000 neurons die every minute. Stroke diagnosis and treatment should be initiated at the earliest time point possible, preferably at the site or during patient transport. Portable ultrasound has been used for prehospital diagnosis for applications other than stroke, and its acceptance as a valuable diagnostic tool “in the field” is growing. The intrahospital use of transcranial ultrasou...
Source: The American Journal of Emergency Medicine - February 14, 2013 Category: Emergency Medicine Authors: Thilo Hölscher, James V. Dunford, Felix Schlachetzki, Sandra Boy, Thomas Hemmen, Brett C. Meyer, John Serra, Jeff Powers, Arne Voie Tags: Reviews Source Type: research

Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation
Abstract: Background: The link between minor troponin (cardiac troponin I [cTnI]) elevations and atrial fibrillation (AF) is still debated.Methods: A total of 948 patients with AF lasting less than 48 hours participated in the study and were required to undergo 1-month and 12-month follow-up. The exclusion criteria were represented by younger than 18 years, the presence of hemodynamic instability, or severe comorbidity. Primary end point was the composite of ischemic vascular events inclusive of stroke, acute coronary syndrome, revascularization, and death.Results: In the short term, 4 patients (5%) of 78 with abnormal cTn...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Alberto Conti, Yuri Mariannini, Gabriele Viviani, Claudio Poggioni, Gabriele Cerini, Margherita Luzzi, Maurizio Zanobetti, Francesca Innocenti, Luigi Padeletti, Gian Franco Gensini Tags: Original Contributions Source Type: research

Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke
We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Chen-Hsiung Huang, Hui-Chun Huang, Kang-Hsu Lin, Wei-Kung Chen, Chon-Haw Tsai Tags: Case Reports Source Type: research

Transient ischemic attack in hereditary hemorrhagic telangiectasia
We describe the case of a 53-year-old woman with a previous history of recurrent epistaxis, admitted to our unit for a transient episode of diplopia and unbalance. Cerebrovascular screening showed the presence of a right to left shunt at saline contrast transcranial Doppler, related to 3 PAVMs detected by subsequent chest computed tomographic scan. Genetic screening evidenced deletion in endoglin gene (ENG), suggesting diagnosis of HHT type 1. Secondary cerebrovascular prevention with antithrombotic therapy was early stopped for the worsening of epistaxis. Neurologic symptoms are common in HHT, and saline contrast transcra...
Source: The American Journal of Emergency Medicine - February 4, 2013 Category: Emergency Medicine Authors: Gino Gialdini, Alberto Chiti, Michelangelo Mancuso, Eva Terni, Nicola Giannini, Giovanni Orlandi Tags: Case Reports Source Type: research

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