Filtered By:
Source: The American Journal of Emergency Medicine
This page shows you your search results in order of date. This is page number 13.
Order by Relevance | Date
Total 261 results found since Jan 2013.
Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training
The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Source: The American Journal of Emergency Medicine - November 28, 2014 Category: Emergency Medicine Authors: Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, Mandy J. Binning 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
Approach to the diagnosis and treatment of acute subarachnoid hemorrhage in a patient with sickle cell disease
We report a case of subarachnoid hemorrhage in a 38-year-old patient with sickle cell anemia. This case highlights the limitations of noncontrast computed tomography in the diagnosis of subarachnoid hemorrhage in patients with sickle cell disease as well as the special needs of this patient population in addressing the treatment of stroke.
Source: The American Journal of Emergency Medicine - August 29, 2014 Category: Emergency Medicine Authors: Matthew Lyon, Justin Jeter, Richard Lottenberg Tags: Case Report Source Type: research
Dabigatran-related coagulopathy: when can we assume the effect has “worn off”?
This issue of American Journal of Emergency Medicine presents a timely report that should be noted by all practicing emergency physicians. Nzwalo et al [1] describe a 61-year-old man with nonvalvular atrial fibrillation, taking 150 mg dabigatran twice daily for stroke protection, who presented to their emergency department (ED) with an acute ischemic stroke (AIS). The patient had a normal creatinine clearance and a normal thrombin time (TT). He was treated with intravenous recombinant tissue plasminogen activator (rt-PA) with good neurologic outcome and no bleeding complications.
Source: The American Journal of Emergency Medicine - August 28, 2014 Category: Emergency Medicine Authors: Charles V. Pollack, Jerrold H. Levy, John Eikelboom, Jeffrey I. Weitz, Frank W. Sellke, Menno V. Huisman, Thorsten Steiner, Pieter Kamphuisen, Richard A. Bernstein Tags: Controversies 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
Intravenous methylphenidate: an unusual way to provoke ST-elevation myocardial infarction
Acute ST-T elevation is a sign of myocardial ischemia or infarction usually due to coronary artery atherosclerosis or coronary spasm. Coronary spasm may be spontaneous or can occur as a result of a drug that causes arterial spam. Ritalin, Novartis Pharmaceut. Corporation, USA (methylphenidate hydrochloride), a dopamine reuptake inhibitor, is an oral drug used to treat attention-deficit/hyperactivity disorder and narcolepsy. Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual dose for attention-deficit/hyperactivity disorder [1].
Source: The American Journal of Emergency Medicine - August 7, 2014 Category: Emergency Medicine Authors: Emile Hay, Vitaly Shklovski, Yossef Blaer, Vladimir Shlakhover, Amos Katz Tags: Case Report 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
Association of physician risk tolerance with emergency department computed tomography use for isolated dizziness/vertigo patients
Dizziness/vertigo is one of the most common principal complaints in the emergency department (ED) [1], accounting for 2.5% of all ED presentations [2]. Although the most common causes of dizziness/vertigo are benign, potential life-threatening stroke especially cerebellar or brain stem infarction should be considered in the differential diagnosis, because isolated dizziness without other concurrent neurological symptoms can be the sole presentation of these conditions [3-5]. Non-contrast brain computed tomography (CT) provides the necessary information for emergency management of most patients with suspected stroke and is ...
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Fu-Jen Cheng, Chien-Hung Wu, Yuan-Jhen Syue, Pai-Chun Yen, Kuan-Han Wu 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
