Treating Ischemic Stroke with tPA in the ED: Time is Brain
Ischemic stroke is an emergent and devastating neurologic disorder, and is a leading cause of both death and disability in the United States. With each minute of brain ischemia, two million neurons are irreversibly damaged. Total ischemic time is linked to functional outcome, and therefore, the role of the Emergency Department is paramount in the management of these patients. Fibrinolytic therapy has become a mainstay of therapy for acute stroke, but guidelines for the use of tPA are dynamic, and often even controversial. When you identify someone with symptoms of stroke, what is your approach to determining if a patient should receive tPA?
The prevalence of hyperthyroidism in the general population is about 1-2%, and is ten times more likely in women than men. The spectrum of hyperthyroidism ranges from asymptomatic or subclinical disease to thyroid storm. So how do we diagnose various presentations of hyperthyroidism in the Emergency Department? Below are answers to 7 common questions that commonly arise.
Imagine a consult service located IN the ED. The consultants are some of the friendliest people you’ve met and are there to help you. They tirelessly go out of their way to guide you through hospital protocols, help you with treatments, keep a close eye on your work, and ensure that you and your patients stay out of trouble. Not only are these consultants helpful to you, but also your residents, mid-levels, nurses, and the admitting teams. Everything they know, they teach you – and some are very active in FOAMed and emergency medicine research.
Derangements in acid-base status are commonly discovered on routine emergency department evaluation and often suggest the presence of severe underlying disease. Many acute conditions can disrupt homeostatic mechanisms used to buffer and excrete acid, and these changes may necessitate immediate intervention. When you discover a patient with an abnormal pH, what is your approach to the diagnosis?