Each year, 22 million people worldwide will experience a stroke. 50% of these are ischemic strokes. For years, there were no effective treatments for these patients. As a result, the burden of ischemic stroke was enormous. Patients often experience debilitating strokes requiring round-the-clock care. Acute ischemic strokes represent the leading cause of disability in our society and the third most common cause of death.
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Hemorrhagic stroke accounts for only 11-22% of all strokes but up to 50% of all stroke mortality. Additionally, there is significant disability associated with the disease in survivors. Much of our attention in the Emergency Department is guided towards preventing expansion of bleeding and secondary injury after the initial insult. Physiologically, controlling blood pressure has always appeared to be a reasonable goal as it may decrease hematoma expansion and thus mortality.
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Spontaneous, non-traumatic, intracerebral hemorrhagic strokes accounts for 11-22% of incidence strokes but 50% of all stroke deaths. There are about 2 million of these bleeds a year world-wide. Many patients with these types of bleeds and strokes in general will be on anti platelet agents like aspirin and clopidogrel. Anti-platelet therapy has been shown to increase incidence of and worsen outcome of spontaneous intracerebral hemorrhage.
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Cardiac ultrasound is an established diagnostic modality in Emergency Medicine (EM). We use it to diagnose pericardial effusions (medical and traumatic), to discern the etiology of shock, to evaluate for congestive heart failure, and to guide treatment and prognosis in cardiac arrest. Nonetheless, the trans-thoracic approach (TTE) to cardiac ultrasound has its limitations: poor windows (in the trauma patient,
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Acute asthma presentations account for more than 2.1 million Emergency Department (ED) visits annually. In the US, 8.4% of the population is affected by the disease. Current guidelines from the National Heart, Lung, and Blood Institute recommend a minimum of 5 days of oral prednisone to treat moderate to severe asthma exacerbations (NHLBI Guidelines 2007).
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Sedation of the agitated and aggressive patient is a frequently encountered problem in the Emergency Department (ED). Whether the etiology of the agitation is intoxication, psychiatric, or organic, these patients require quick and efficient chemical sedation because they are both a danger to themselves and others in the ED. The majority of these patients are successfully sedated with antipsychotics or benzodiazepines (Downes 2009).
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Thanks to Salim Rezaie for providing pre-publication peer review for this post. This post is cross-posted on REBEL EM here.
Despite continued debate on the efficacy of alteplase (tPA), it currently remains one of the major interventions directed at patients presenting with acute ischemic stroke. The current standard dose of the drug is 0.9 mg/kg given over 1 hour.
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Every year in the United States there are an estimated 178.8 million episodes of acute gastroenteritis resulting in 473,832 hospitalizations. Most of the evidence surrounding oral rehydration centers around Oral Rehydration Therapy (ORT) studies in low-income countries where children suffer from more extensive gastrointestinal losses. Theoretically, electrolyte maintenance solutions are recommended in order to prevent increasing diarrheal losses through the osmotic diuresis that can occur with glucose-rich drinks like juice.
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