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Higher prehospital blood pressure prolongs door to needle thrombolysis times: a target for quality improvement?
Per the American Heart Association guidelines, blood pressure (BP) should be less than 185/110 to be eligible for stroke thrombolysis. No studies have focused on prehospital BP and its impact on door to needle (DTN) times. We hypothesized that DTN times would be longer for patients with higher prehospital BP.
Source: The American Journal of Emergency Medicine - April 15, 2016 Category: Emergency Medicine Authors: Digvijaya D. Navalkele, Chunyan Cai, Farhaan Vahidy, Mohammad H. Rahbar, Renganayaki Pandurengan, Tzu-Ching Wu, Amrou Sarraj, Andrew Barreto, James C. Grotta, Nicole Gonzales Tags: Brief Report Source Type: research

Brugada electrocardiogram pattern induced by cannabis; is cannabis safe?
The objective of this study was to present a case report that brings attention to relationship between cannabis consumption and Brugada electrocardiogram pattern. Here, we present a case of a 19-year-old male patient with symptomatic Brugada electrocardiogram pattern induced after cannabis consumption. With the potential for more widespread legalization of cannabis, several studies are raising the issue of adverse vascular effects of cannabis, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis.
Source: The American Journal of Emergency Medicine - December 29, 2015 Category: Emergency Medicine Authors: Joaqu ín Valle Alonso, Beatrix Huei-Yi Teo, F. Javier Fonseca del Pozo, Miguel Angel Aguayo, Almudena Sanchez Tags: Case Report Source Type: research

Safety of Direct Oral Anticoagulants: Insights from Postmarketing Studies
Direct oral anticoagulants (DOACs) have been marketed in the United States since 2010. While numerous large-scale prospective phase 3 outcomes studies have documented the effectiveness of DOACs for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, the primary safety concern with all of these drugs —as it is with the more established oral anticoagulant warfarin—is the risk of major bleeding. Postmarketing surveillance studies (PMSS) provide the opportunity to evaluate the safety of these recently approved drugs across a spectrum of patients that may be broader than those in...
Source: The American Journal of Emergency Medicine - September 27, 2016 Category: Emergency Medicine Authors: Todd C. Villines, W. Frank Peacock Tags: Review Source Type: research

Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups
ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed.
Source: The American Journal of Emergency Medicine - April 29, 2017 Category: Emergency Medicine Authors: Emre G ökcen, İbrahim Caltekin, Atakan Savrun, Hilal Korkmaz, Şeyda Tuba Savrun, Gökhan Yıldırım 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

Predictors of false negative diffusion-weighted MRI in clinically suspected central cause of vertigo
Vertigo is classified as peripheral and central. Differentiation of stroke mimics is the most important diagnostic challenge. There is no clinical guidance for the indications of neuroimaging in isolated vertigo patients. The primary aim of this study is to test the diagnostic value of a DWI-MRI protocol to rule-out a central cause in patients with acute isolated vertigo in the ED.
Source: The American Journal of Emergency Medicine - September 23, 2017 Category: Emergency Medicine Authors: Ebru Unal Akoglu, Haldun Akoglu, Tuba Cimilli Ozturk, Bahaeddin Onur, Serkan Emre Eroglu, Ozge Onur, Arzu Denizbasi 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, Wei-Fong Kao, Shin-Han Tsai 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

Comments on “Inter-facility transfer for patients with acute large vessel occlusion stroke receiving mechanical thrombectomy.”
We read the recently-published article by Schevin et al. [1] with great interest. We commended the authors for looking into the work flow in Emergency Departments (ED) in patients with acute ischemia from large vessel occlusion (AIS-LVO) to assess where the longest delays to thrombectomy might occur. Unfortunately, this study is significantly underpowered to comment on patient outcomes. In this retrospective study of 95 patients undergoing mechanical thrombectomy (MT), the authors showed that patients' total ED length of stay and successful MT were not associated with good neurological outcome, defined as 90-day modified R...
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Quincy K. Tran, Nicholas Morris Source Type: research

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