There has been a lot of debate over the recent years about the safety of crystalloid fluid therapy in acutely ill patients. Several observational studies have shown an increased risk of acute kidney injury (AKI) with the use of normal saline (NS). Other observational studies have shown a decreased risk of AKI when using a buffered solution (Hartmann’s solution, Plasma-Lyte (PL)). What is the best fluid to give to our patients who need fluid resuscitation? The answer to this question is not known, but another step in finding the answer was taken with the release of the SPLIT trial online by JAMA on October 7, 2015.
As emergency physicians, we are constantly on the look out for elevated blood pressures and the potential devastating consequences. We are concerned about intracranial bleeds and acute pulmonary edema from heart failure. But what about the patient that comes in with high blood pressures, yet has no symptoms? Do we need to treat the number or the patient? In this post we will tackle this clinical dilemma of elevated asymptomatic hypertension: To treat or not to treat?...Read More
For the most part, the biggest concern with administering tPA is the bleeding complications, specifically intracranial hemorrhage. But there is another side effect that is being reported more frequently. I, myself, saw two cases in one week. This side effect is tPA-associated angioedema.
Case: A 70-year-old female with a past medical history of hypertension and diabetes presents to your department 45 minutes after onset of left facial droop, slurred speech and left-sided hemiparesis. The initial head CT is negative for acute hemorrhage. You diagnose your patient with an acute ischemic stroke. There are no contraindications, so you decide to treat the patient with tPA (we will leave this debate for another time).