Test Your Knowledge: Acute Ischemic Stroke
August 23, 2021


Posted by Andy Jagoda MD in: Brain Tease , 1 comment so far

Acute ischemic stroke is a leading cause of morbidity and mortality in the United States, and a majority of acute ischemic stroke patients are evaluated for the first time by a clinician in the emergency department. read more

Clinical Pathway for Management of Acute Ischemic Stroke After the 3-Hour Time Window
July 20, 2021


Posted by Andy Jagoda MD in: Feature Update , add a comment

Acute ischemic stroke is a leading cause of morbidity and mortality in the United States, and a majority of acute ischemic stroke patients are evaluated for the first time by a clinician in the emergency department. Our recent issue Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window presents evidence-based guidelines for the diagnosis and treatment of acute ischemic stroke in patients who present more than 3 hours after their last known well time. read more

Current Topics in Acute Stroke Care: Clinical Pathway for Acute Management of Central Retinal Artery Occlusion
August 10, 2020


Posted by Andy Jagoda MD in: Algorithms , 1 comment so far

Clinicians are highly likely to encounter patients with stroke in the emergency department and must be able to diagnose and manage stroke in a timely and effective manner to optimize patient outcomes. Emergency department management of stroke includes utilizing imaging appropriately based on the type of stroke, assessing patient risk for additional cardiovascular or stroke events, and recognizing subtle or different forms of stroke, such as patients who have normal initial imaging or patients who present with a central retinal artery occlusion.  read more

Test Your Knowledge: Evaluation and Management of Life-Threatening Headaches in the ED
February 6, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Emergency Medicine Practice Blog Brain Teaser

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered ?benign.? It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively. read more

How to unlock 40% more LLSA options
January 29, 2020


Posted by Andy Jagoda, MD in: Algorithms , add a comment

You just finished a rewarding but intensely grueling day.

Caseloads were high, patients were demanding, and time to JUST BREATHE was scarce.

You give your inbox a quick glance before going home to get some sleep so you can do it all again tomorrow, and one email yells for your attention: ?REMINDER! LLSA requirement for your ABEM certification.? Yikes. Just what you need? one more thing on your plate. You buckle down to fork out $$ and precious time to meet your ABEM certification requirement.

Unlock more LLSA options read more

Risk Management Pitfalls in the Management of Pediatric Stroke
January 21, 2020


Posted by Andy Jagoda, MD in: Risk Management Pitfalls , 1 comment so far

Stroke is a leading cause of morbidity and mortality in children. The etiologies, risk factors, and presentation of stroke differ from those of adults, and the diagnosis of stroke is often delayed in children. The management of pediatric stroke can be challenging because there are few data to support the efficacy of interventions. read more

What’s Your Diagnosis? Patient With Acute Dizziness
November 29, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 3 comments

But before we begin, check out if you got last month’s case, on Pain Management: Beyond Opioids, right. Click here to check out the answer! read more

Test Your Knowledge: Pediatric Stroke: Diagnosis and Management in the ED
November 21, 2019


Posted by Andy Jagoda, MD in: Brain Tease , add a comment

Stroke is a leading cause of morbidity and mortality in children. The etiologies, risk factors, and presentation of stroke differ from those of adults, and the diagnosis of stroke is often delayed in children. The management of pediatric stroke can be challenging because there are few data to support the efficacy of interventions.

Test your knowledge and see if you’d spot stroke in a pediatric patient!

Please enable javascript to answer the question.

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The correct answer: B.

$( ".question22" ).click(function() { //When the question is clicked on. . .
$( this).find("p").toggle( "medium" ); //toggle the child paragraph.
});

Review this Pediatric Emergency Medicine Practice issue to get up-to-date on the most common causes of pediatric stroke, provides guidance for distinguishing stroke from stroke mimics, discusses the indications for diagnostic studies, and offers evidence-based recommendations for treatment in the emergency department.

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What’s Your Diagnosis? a 7-year-old boy after a generalized seizure lasting 2 minutes
November 1, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 4 comments

But before we begin, check out if you got last month’s case right, about the 9-month-old infant gasping for air. Click here to check out the answer! read more

Intravenous Thrombolysis in Acute Ischemic Stroke
July 17, 2019


Posted by Andy Jagoda, MD in: Algorithms , add a comment

Stroke is the fifth leading cause of death in the United States and an important cause of long-term disability. Approximately 795,000 people suffer from stroke each year (610,000 primary strokes and 185,000 recurrent strokes),1 with ischemic stroke representing the vast majority of all stroke types (87%).

The cornerstone of acute ischemic stroke treatment relies on rapid clearance of an offending thrombus in the cerebrovascular system. Advanced neuroimaging and clinical trials, together with continuous adjustments of inclusion/exclusion criteria, have helped emergency clinicians to rapidly and more accurately identify the patients who will benefit from acute stroke treatment.

Inclusion and Exclusion of Intravenous Thrombolysis: A Changing Landscape

The American Heart Association (AHA) recently published updated guidelines for stroke management. Table 1, summarizes the updated 2018 AHA indications and contraindications for treatment with IVT. Every patient presenting with symptoms of acute stroke within 4.5 hours of last known well or usual state should be triaged for potential IVT. Patients should be evaluated with computed tomography (CT) scan of the brain and systolic blood pressure (SBP) should be maintained at < 185 mm Hg and diastolic blood pressure (DBP) at < 110 mm Hg. Every eligible patient should receive IVT without delay. Changes and adjustments of inclusion/exclusion criteria (in order to minimize the risk of any complication) have been made and are discussed in following sections.

Table 1. Eligibility Criteria and Exclusion Criteria for Intravenous Thrombolysis
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