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Source: The American Journal of Emergency Medicine
Condition: Stroke
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Total 254 results found since Jan 2013.
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
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
Red blood cell distribution width is associated with mortality in elderly patients with sepsis
RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.
Source: The American Journal of Emergency Medicine - October 25, 2017 Category: Emergency Medicine Authors: An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang 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
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 7, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Jacob A. Reeder, Mohammed A. Alkhalifah, David A. Moran, Michael A. Corvino 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 6, 2019 Category: Emergency Medicine Authors: Osman L ütfi Demirci, Gülşah Çıkrıkçı Işık, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research
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 13, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn Source Type: research
A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy
An asymptomatic 83-year-old man with a history of hypertension, prior stroke with no residual deficits, and bilateral carotid artery stenosis, presented for evaluation prior to cataract surgery. His transthoracic echocardiogram was typical for apical hypertrophic cardiomyopathy (AHCM), and his electrocardiograms (ECG) showed large precordial R-waves and inverted T-waves, previously associated with AHCM, while his ECG 7 years earlier was normal. Mechanistic explanations for the developed ECG abnormalities, and their importance for the detection and monitoring of patients with AHCM are provided.
Source: The American Journal of Emergency Medicine - March 4, 2020 Category: Emergency Medicine Authors: Benjamin Gold, John Madias Source Type: research
Is caval index an appropriate tool for predicting hypovolemia in stroke
We have read with interest the recent article, “Challenge of Intravascular Volume Assessment in Acute Ischemic Stroke” by Miller J.B. et al. [1].
Source: The American Journal of Emergency Medicine - March 11, 2020 Category: Emergency Medicine Authors: Engin Ozakin, Kadir Ugur Mert Source Type: research
COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens
Reports have been published from multiple countries regarding increased thrombus formation in COVID-19 patients, especially critically ill patients. These include DVT formation as well as pulmonary embolism and stroke. Currently, the exact mechanism as to why COVID-19 patients are at higher risk for thrombotic complications has not been determined. It has been thought to be due to endothelial injury, blood stasis or a hypercoagulable state [1]. To our knowledge this is the first reported case of phlegmasia cerulea dolens in a patient diagnosed with COVID-19.
Source: The American Journal of Emergency Medicine - May 14, 2020 Category: Emergency Medicine Authors: Michael H. Morales, Candace L. Leigh, Erin L. Simon Source Type: research
Priapism in a patient with coronavirus disease 2019 (COVID-19): A case report
Thromboembolic complications related to SARS-CoV-2 have been extensively reported. They include deep vein thrombosis, pulmonary embolism, ischemic stroke, and acute coronary syndrome. Penile thrombosis has not been reported as a thrombotic complication of SARS-CoV-2 infection with hypercoagulability.Here we describe a case of priapism as a thromboembolic complication in a patient with COVID-19 who recovered from acute respiratory distress syndrome (ARDS). We discuss the underlying pathophysiological mechanisms mainly related to an hypercoagulability state.
Source: The American Journal of Emergency Medicine - June 16, 2020 Category: Emergency Medicine Authors: Myriam Lamamri, Ala Chebbi, Jordan Mamane, Sofia Abbad, Milena Munuzzolini, Florence Sarfati, St éphane Legriel Source Type: research
