Background: Currently, alteplase is the mainstay of treatment of acute ischemic stroke. Advocates of alteplase suggest that the benefit of alteplase is greatest when given early and declines with increasing time from stroke symptom onset (i.e. time is brain). Therefore, the AHA/ASA guidelines recommend intravenous alteplase within 4.5 hours after stroke onset, which is based on very weak evidence (i.e. NINDS & ECASS III).
Due to weak evidence in support of it’s use and significant patient risks associated with alteplase, it’s use in acute ischemic stroke remains controversial. One of the big issues is that by decreasing the time for evaluation and treatment, there is an increased risk of administrating alteplase to patients presenting with noncerebrovascular conditions that can resemble an acute ischemic stroke (i.e. stroke mimics). This puts patients with no chance of improvement with alteplase at risk for increased mortality and symptomatic ICH. There is some limited data on the safety of alteplase in stroke mimics and this study adds to that knowledge....Read More
Have you ever wondered how to get your text color to match your image color? It’s not hard and can make a good slide become an amazing slide. Matching colors make consistent, professional-looking PowerPoint or Keynote slides. The steps to make this happen are very simple and in this post, I will hopefully show you how it’s done. This feature is available from PowerPoint 2013 on, but not on older versions (This can also be done on keynote)....Read More
Background: Follow-up with a primary care (PC) provider is an important part of healthcare. Many countries have a robust outpatient system, and the US is no different. However, in the US, there are many challenges to follow up including: appointment availability, insurance status, unclear discharge instructions and socioeconomic status. Removing some of these barriers by scheduling an appointment before ED discharge could potentially increase outpatient follow up. Use of a simple, low resource bedside intervention that schedules follow-up appointments prior to ED discharge could improve health outcomes and decrease return ED visits....Read More
Background Information: Atrial fibrillation is the most commonly encountered dysrhythmia in the emergency department (ED) and is associated with an increased long-term risk of stroke, heart-failure and all-cause mortality.1,2 In fact, the overall mortality rate for patients with atrial fibrillation is approximately double that of patients in normal sinus.3,4 The decision to rate vs. rhythm control patients while in the emergency department remains controversial in the literature and the method of doing so using chemical vs. electrical cardioversion also stirs up debate. Prior studies have shown the success rate of electrical cardioversion alone to be 90%.1,5 other studies have demonstrated that emergency physicians use each strategy roughly half the time.1 The authors of this study sought to determine if one of the two strategies resulted in achievement of normal sinus rhythm and discharge more quickly....Read More
Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management. There are several vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). All three techniques aim to increase vagal tone to slow down conduction in the AV node and, hopefully, result in termination of Atrioventricular nodal reentry tachycardia (AVNRT)and atrioventricular reentrant tachycardia (AVRT). The authors of this trial performed a RCT evaluating the effectiveness of sVM vs mVM vs CSM at not only terminating SVT but also having a sustained effect up to 5 minutes....Read More