Does it Take a VAN to Identify Emergent Large Vessel Occlusion (ELVO) in Ischemic Stroke?

27 Mar
March 27, 2018

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 →

REBEL Cast Ep 47: Blood Transfusions, Lidocaine for Kidney Stones, and Stop Using So Much Oxygen

26 Mar
March 26, 2018

Background: Welcome back to REBEL Cast episode 47.  In this issue we are going to talk about some recent trials published in the past year that have gotten some love in the FOAMed world.  We have been meaning to discuss these trials, but just simply didn’t have the time until now.  What trials are we reviewing?

  • The age of PRBCs in transfusion
  • The usefulness of lidocaine in renal colic
  • The utility of oxygen therapy in Stroke

Read more →

D-Dimer and Pregnancy: The DiPEP Study

19 Mar
March 19, 2018

Background: Pulmonary embolism is the leading cause of death in pregnancy and the puerperium – accounting for nearly 20% of maternal deaths in the United States – making rapid and accurate diagnosis critically important for emergency physicians, OB/GYNs, and all who take care of these women on a regular basis. Unfortunately, typical diagnostic pathways and approaches may not apply in pregnancy, and are made more complicated by the frequency of concerning and suggestive signs and symptoms in this population, particularly dyspnea (a common symptom in pregnancy related to an increase in progesterone levels) and tachycardia (as resting heart rate is typically expected to increase by up to 25% in normal pregnancy). Read more →

Endovascular Therapy for Acute Ischemic Stroke

15 Mar
March 15, 2018

Background: Approximately 80% of strokes are ischemic in origin leading to significant morbidity and mortality worldwide.  In ischemic stroke, there is usually a core infarct and an ischemic penumbra.  The penumbra is the area that we try to salvage with reperfusion therapy. Currently, systematic intravenous alteplase administered within 4.5hrs after symptom onset is the mainstay of therapy, however many question its risk/benefit ratio in ischemic stroke. 4.5 hours is a narrow therapeutic time window and many contraindications such as recent surgery, coagulation abnormalities, and history of intracranial hemorrhage inhibit many patients from receiving systemic thrombolysis.  There have been many studies evaluating endovascular therapy in the management of ischemic stroke published in the past few years.  This post will serve as a review of those studies. Read more →

REBEL Cast Ep 46b: Vent Management in the Crashing Patient with Haney Mallemat

12 Mar
March 12, 2018

In Episode 46a we discussed respiratory failure and NIV.  In episode 46b we are going move on to the patient where you have tried NIV and your patient just doesn’t seem to be improving.  You decide to intubate your patient and connect them to the ventilator.  Now the ventilator starts beeping and your patient begins to decompensate.  What are the steps you use to assess the problem and fix it? Read more →

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