Background: Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs). This group of strokes typically includes patients with occlusion of the distal intracranial carotid artery, middle cerebral artery or anterior cerebral artery. Rapid identification of these patients both in the prehospital setting as well as in the emergency department (ED) may be beneficial as it can lead to mobilization of necessary resources and ordering of proper investigations (CT perfusion, MRI/MRA). While there are a number of clinical scoring systems in place to identify patients with LVO, none are ideal. The authors investigate the utility of the vision, aphasia, neglect (VAN) assessment for this purpose. Read more →
Author Archive for: Swami
Definition: Orthostatic hypotension (OH) is a form of low blood pressure that occurs with positional change (i.e. sitting up from lying down, standing up from sitting). It is commonly used for the diagnosis of volume depletion
Orthostatic Vital Signs
- A reduction of systolic blood pressure (SBP) of at least 20 mm Hg
- A reduction in diastolic blood pressure (DBP) of at least 10 mm Hg
- An increase in heart rate (HR) by > 30 beats per minute
One of the above criteria must be met while measured 3 minutes after standing from a supine position.
Clinical Question: Are orthostatic vital signs useful in finding patients with occult volume loss? Do they add to our standard clinical assessment of patients? Read more →
What’s Wrong With Lectures/Presentations Now?
- Lecturing style has remained stagnant despite the fact that our understanding of how people learn has changed.
- Most presentations make the supportive media (i.e. slides) the focus of the presentation without thought about the story or the delivery.
- Lectures are too focused on the educator instead of focusing on the needs of the learner.
Background: Post-cardiac arrest patients are among the sickest groups of patients seen in the Emergency Department. They are difficult to study, which leads to endless questions about how to best care for them. Below we address the available evidence on four of these controversies: oxygen therapy, hemodynamic management, cardiac catheterization and head CT. We recognize the limitations to the available data and attempt to offer the best recommendations we can. Read more →
Background: Placement of vascular access for administration of resuscitation drugs and fluids is a common procedure in the management of out of hospital cardiac arrest (OHCA). While intravenous (IV) placement has been the standard approach for decades, intraosseous (IO) access is rapid and safe and may be the preferred approach due to fact that the bone marrow does not collapse during shock states as peripheral veins often do. Despite it’s advantages, there are concerns about IO placement because of the potential for drugs to pool in the marrow and not circulate. Prior studies have shown an association with tibial IO placement and decreased rate of ROSC though no association with worse neurologic outcomes (Feinstein 2017). Read more →