Stroke in the Emergency Department
0

Can’t Miss Stroke in the Emergency Department (Stroke CME and Pharmacology CME)

This resource combines video and digital components to review the evaluation and management of stroke in the setting of life-threatening headaches and dizziness, as well as stroke in pediatric patients. Includes 14.5 AMA PRA Category 1 Credits™. Included as part of the 14.5 credits, this CME activity is eligible for 11.5 Stroke CME credits and 1.25 Pharmacology CME credits.

Modules

We hope you enjoy this course! If you have any questions, our Customer Service Team is here to help Monday - Friday, 9:00am-5:30pm EST, and can be reached at 678-366-7933 or ebm@ebmedicine.net

Authors

David Zodda, MD, FACEP
Assistant Program Director, Emergency Medicine Residency, Hackensack University Medical and Trauma Center; Assistant Professor, Department of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
Gabrielle Procopio, PharmD, BCPS
Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Hackensack University Medical and Trauma Center; Assistant Professor, Department of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
Amit Gupta, MD
Assistant Program Director, Emergency Medicine Residency, Hackensack University Medical and Trauma Center; Assistant Professor, Department of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall Medical School, Hackensack, NJ
Jonathan A. Edlow, MD, FACEP
Vice-Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Professor of Emergency Medicine, Harvard Medical School, Boston, MA

Peer Reviewers

Mert Erogul, MD
Attending Physician, Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY
Steven A. Godwin, MD, FACEP
Professor and Chair, Department of Emergency Medicine; Assistant Dean, Simulation Education, University of Florida College of Medicine- Jacksonville, Jacksonville, FL
Petra Duran-Gehring, MD, RDMS, FACEP
Associate Professor, Department of Emergency Medicine, Director of Emergency Ultrasound, University of Florida College of Medicine- Jacksonville, Jacksonville, FL
Christopher Lewandowski, MD
Clinical Professor of Emergency Medicine, Wayne State University School of Medicine; Executive Vice Chair, Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
Vasisht Srinivasan, MD
Clinical Instructor, Department of Emergency Medicine; Fellow, Division of Critical Care, Department of Neurology and Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnati, OH

Video Presenters

Edward P. Sloan, MD
Medical Director at Dominican University in Illinois and Professor Emeritus at UIC Emergency Medicine
Sam Ashoo, MD
Emergency physician practicing in Tallahassee, Florida and is board certified in emergency medicine and clinical informatics

Product Details

Publication Date: November 1, 2020

CME Expiration Date: December 01, 2022

CME Information: Included as part of the 14.5 credits, this CME activity is eligible for 11.5 Stroke CME credits and 1.25 Pharmacology CME credits. EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME. Credit Designation: EB Medicine designates this enduring material for a maximum of 14.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The Evaluation and Management of Life-Threatening Headaches in the Emergency Department and The Timing-and-Triggers Approach to the Patient With Acute Dizziness journal issues of Can’t Miss Stroke in the Emergency Department are approved by the American College of Emergency Physicians for 4 hours of Category I credit each. Can’t Miss Stroke in the Emergency Department is eligible for 14.5 Category 2-A or 2-B credit hours by the American Osteopathic Association.

Table of Contents

Course 1: Evaluation and Management of Life-Threatening Headaches in the Emergency Department + EMplify podcast audio summary

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology and Pathophysiology
  6. Differential Diagnosis
    1. Subarachnoid Hemorrhage
    2. Cervical Artery Dissection
    3. Cerebral Venous Thrombosis
    4. Idiopathic Intracranial Hypertension
    5. Giant Cell Arteritis
    6. Posterior Reversible Encephalopathy Syndrome
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. History
    2. Physical Examination
      1. Vital Signs
      2. Neurologic Function
      3. Cranial Nerves
      4. Head and Neck Examination
      5. Fundoscopic Examination
  9. Diagnostic Studies
    1. Laboratory Testing
    2. Radiographic Imaging
      1. Level B Recommendations (Moderate Strength of Evidence)
      2. Level C Recommendations (Weak Strength of Evidence)
      3. Computed Tomography and Subarachnoid Hemorrhage
    3. Lumbar Puncture
    4. Ocular Ultrasonography
  10. Treatment
    1. Subarachnoid Hemorrhage
    2. Cerebral Venous Thrombosis
    3. Idiopathic Intracranial Hypertension
    4. Posterior Reversible Encephalopathy Syndrome
    5. Cervical Artery Dissection
    6. Acute Angle Closure Glaucoma
    7. Giant Cell Arteritis
    8. Pre-Eclampsia
  11. Controversies and Cutting Edge
  12. Disposition
  13. Summary
  14. Risk Management Pitfalls for Emergency Department Management of Severe, Sudden Onset Headache
  15. Time- And Cost-Effective Strategies
  16. Case Conclusions
  17. Clinical Pathway for Emergency Department Management of Subarachnoid Hemorrhage
  18. Tables and Figures
    1. Table 1. Life-Threatening Secondary Causes of Headache
    2. Table 2. Historical and Physical Examination Findings Associated with Subarachnoid Hemorrhage
    3. Table 3. Red Flags for Life-Threatening Headaches
    4. Table 4. Historical Factors and Concerning Descriptors
    5. Table 5. Stepwise Approach to the Fundoscopic Examination
    6. Table 6. Intravenous Antihypertensive Medications for Treating Hypertensive Emergencies
    7. Table 7. Ottawa Subarachnoid Hemorrhage Rule
    8. Table 8. Modified Dandy Criteria for Diagnosing Idiopathic Intracranial Hypertension
    9. Table 9. Medications for Treatment of Acute Angle Closure Glaucoma
    10. Table 10. Criteria for the Diagnosis of Pre Eclampsia (>= 20 Weeks' Gestation)
    11. Figure 1. Ocular Ultrasound Evaluating Elevated Intracranial Pressure
  19. References

Course 2: The Timing-and-Triggers Approach to the Patient With Acute Dizziness

  1. Abstract
  2. Case Presentations
  3. Selected Abbreviations
  4. Introduction
  5. Critical Appraisal of the Literature
  6. Etiology, Relevant Anatomy, Physiology, and Pathophysiology
  7. Differential Diagnosis, Diagnostic Approach, and Misdiagnosis
    1. Symptom-Quality Approach
    2. Timing-and-Triggers Approach
    3. Misdiagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. Acute Vestibular Syndrome
      1. Head Impulse–Nystagmus–Test of Skew (HINTS) Testing
        • Test 1: Nystagmus Testing
        • Test 2: Skew Deviation Testing
        • Test 3: Head Impulse Testing
        • Test 4: Targeted Examination
        • Test 5: Gait Testing
    2. Spontaneous Episodic Vestibular Syndrome
    3. Triggered Episodic Vestibular Syndrome
  10. Diagnostic Studies
  11. Treatment
  12. Special Populations
  13. Controversies and Cutting Edge
  14. Disposition
  15. Summary
  16. Time- and Cost-Effective Strategies
  17. Key Points
  18. Risk Management Pitfalls for Dizziness in the Emergency Department
  19. Case Conclusions
  20. Clinical Pathways
    1. Clinical Pathway for the ATTEST Approach to Emergency Department Patients With Acute Dizziness
    2. Clinical Pathway for Diagnostic Evaluation of Patients With an Acute Vestibular Syndrome
  21. Tables and Figures
    1. Table 1. Timing-and-Trigger-Based Vestibulara Syndromes in Acute Dizziness and Their Corresponding Differential Diagnosis
    2. Table 2. Summary of Useful Physical Examination Findings in Symptomatic Patients With the Acute Vestibular Syndrome
    3. Table 3. Diagnostic Criteria for Vestibular Migraine
    4. Table 4. Benign Paroxysmal Positional Vertigo Physical Examination, Type of Nystagmus, and Therapeutic Maneuvers
    5. Table 5. Characteristics of Patients With Triggered Episodic Vestibular Syndrome That Suggest a Central Mimic (CPPV) Rather Than Typical BPPV
    6. Figure 1. Inner Ear Anatomy
    7. Figure 2. Vestibular Anatomy and Physiology
    8. Figure 3. Mechanisms of Benign Paroxysmal Positional Vertigo
    9. Figure 4. Cerebrovascular Anatomy of the Labyrinth
    10. Figure 5. Head Impulse Test
  22. Video Links
    1. Dix-Hallpike Maneuver
    2. Epley Maneuver
    3. Lempert (“barbecue”) maneuver
    4. Foster half-somersault maneuver for pc-BPPV
    5. Semont (liberatory) maneuver
    6. Gufoni maneuver
  23. Reference

Course 3: Pediatric Stroke: Diagnosis and Management in the Emergency Department - Stroke EXTRA Supplement

  1. Key Points
  2. Abstract
  3. Case Presentations
  4. Introduction
  5. Critical Appraisal of the Literature
  6. Etiology and Pathophysiology
    1. Ischemic Stroke
      1. Arteriopathies
      2. Cardiac Etiologies
      3. Prothrombotic States
      4. Systemic Disorders
    2. Cerebral Sinus Venous Thrombosis
    3. Hemorrhagic Stroke
  7. Differential Diagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. History
    2. Physical Examination
  10. Diagnostic Studies
  11. Treatment
    1. Ischemic Stroke
      1. Arterial Ischemic Stroke
      2. Thrombolytics
      3. Mechanical Thrombectomy
      4. Sickle Cell Disease
      5. Summary
    2. Hemorrhagic Stroke
  12. Special Populations
    1. Patients With Sickle Cell Disease
    2. Neonates
  13. Controversies and Cutting Edge
    1. Therapies for Pediatric Stroke
    2. Pediatric Stroke Protocols
  14. Disposition
  15. Summary
  16. Time- and Cost-Effective Strategies
  17. Risk Management Pitfalls in the Management of Pediatric Stroke
  18. Case Conclusions
  19. Clinical Pathway for Management of Pediatric Stroke
  20. Tables and Figures
    1. Table 1. Hypercoagulable States Associated With Pediatric Arterial Ischemic Stroke
    2. Table 2. Differential Diagnosis for Pediatric Stroke
    3. Table 3. Pediatric National Institutes of Health Stroke Scale (PedNIHSS)
    4. Table 4. Medications for Ischemic Stroke
    5. Table 5. Antithrombotic Medication Reversal Agents
    6. Figure 1. Moyamoya Syndrome on Magnetic Resonance Angiogram
  21. References

 

Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.