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("Thrombolysis" OR "Thrombolytic") AND "Emergency"

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https://www.readbyqxmd.com/read/30317687/endovascular-stroke-treatment-does-not-preclude-high-thrombolysis-rates
#1
Sarina Feda, Omid Nikoubashman, Kolja Schürmann, Oliver Matz, Simone C Tauber, Martin Wiesmann, Jörg B Schulz, Arno Reich
BACKGROUND: In 1995 intravenous recombinant tissue plasminogen activator (IVRTPA) was the first reperfusion therapy to be approved in patients with acute ischemic stroke (AIS). The significance and impact of IVRTPA in times of modern endovascular stroke treatment (EST) was analyzed in a German academic stroke centre. METHODS: A retrospective observational cohort analysis of 1.034 patients with suspected AIS presenting at the emergency department in 2014 was performed...
October 14, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/30290914/-thrombolysis-in-pulmonary-embolism-with-high-mortality-risk-experience-of-a-cardiology-department-in-sub-saharan-africa
#2
S Pessinaba, Y D M Atti, S Baragou, K Yayehd, M Pio, Y M Afassinou, M Kpelafia, W D Kaziga, M F Simwetare, R D'alméida, M Aloumon, M Agbétiafa, N Panchut Nsangou, F Damorou
INTRODUCTION: High-risk pulmonary embolism (PE) accounts for 5% of total acute PE and is a life-threatening emergency requiring immediate therapeutic management by fibrinolysis. The objective of this work is to describe the experience of thrombolysis in high-risk PE in a cardiology department in Togo. PATIENTS AND METHODS: This is an analytical and descriptive study carried out in the cardiology department of the Campus teaching hospital of Lomé over a period of 5 years (August 2012 to July 2017) concerning patients hospitalized for high-risk mortality PE and having undergone streptokinase thrombolysis...
October 2, 2018: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/30286670/pharmacological-thrombolysis-the-last-choice-for-salvaging-free-flaps
#3
Sik Namgoong, Jong-Phil Yang, Seong Ho Jeong, Seung Kyu Han, Woo Kyung Kim, Eun Sang Dhong
Microvascular free flap transfer has become a prevailing surgery with a failure rate of <5%. However, pedicle thrombosis occurs more frequently than indicated by the failure rate. This difference is due to the successful salvage of failing flaps. During exploration, thrombi are often encountered at anastomotic sites, whereas these causes could not explain vascular compromise in other patients. Thus, we hypothesized that thrombogenic processes might occur at remote sites, specifically within microvessels of the transferred flap...
October 4, 2018: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/30279833/a-case-of-upper-extremity-deep-vein-thrombosis-with-long-term-patency-using-pharmaco-mechanical-catheter-directed-thrombolysis-in-the-acute-phase
#4
Tomoya Hasegawa, Hiroaki Tabata, Mitsuru Kagoshima
Although upper-extremity deep vein thrombosis (UEDVT) is considered rare, its prevalence appears to be increasing, and this may be related to expanding indications for catheter-based interventions. In contrast, few cases have been reported related to strenuous exercise, especially in healthy young adults with thoracic outlet syndrome (Paget-Schroetter syndrome). In contrast to lower-extremity DVT, optimal treatment strategies for UEDVT have not been robustly studied. In this report, we describe a 56-year-old man with primary UEDVT presenting with left arm swelling, paresthesia, and visible collateral veins around the shoulder...
December 2017: Journal of Cardiology Cases
https://www.readbyqxmd.com/read/30279828/acute-ischemic-stroke-what-is-hidden-behind
#5
Joaquín Valle Alonso, David Martin, Harriet Kinderman, Islam Farhad, Peter Swallow, Aidan Siggers
Acute aortic dissection (AAD) is a rare and potentially fatal disease. The classic presentation is sudden and severe pain in the chest, back, or abdomen, described as tearing or ripping pain radiating to the interscapular region. Cerebral ischemic complications occur in 18-30% of aortic dissections and patients may present to the emergency department (ED) with isolated focal neurology and no chest pain. In AAD patients, presenting with stroke and subsequently thrombolized, a 71% mortality rate has been reported in patients receiving recombinant tissue plasminogen activator (r-TPA)...
November 2017: Journal of Cardiology Cases
https://www.readbyqxmd.com/read/30279825/thrombolytic-treatment-for-acute-prosthetic-valve-thrombosis-is-it-better-than-surgery
#6
Diego Araiza-Garaygordobil, Luis Antonio Aguilar-Rojas, Salvador Mendoza-García, Ricardo Leopoldo Barajas-Campos, Santiago Casal-Alonso, José Luis Briseño-de-la-Cruz, Alexandra Arias-Mendoza
Prosthetic valve thrombosis (PVT) is a rare but often lethal complication of valve replacement. Despite advances in surgical techniques, surgical mortality remains high and emergent cardiac surgery is not widely available. Herein, we present the case of an acute PVT successfully treated with thrombolytic therapy. A 48-year-old female presented to the emergency department with acute onset of shortness of breath. Her medical history was remarkable for mitral valve replacement at the age of 42 years. Her symptoms began 4 h before, when she suddenly presented severe resting dyspnea...
November 2017: Journal of Cardiology Cases
https://www.readbyqxmd.com/read/30261390/transradial-mechanical-thrombectomy-for-proximal-mca-occlusion-in-a-first-trimester-pregnancy-case-report-and-literature-review
#7
Sumedh S Shah, Brian M Snelling, Marie Christine Brunet, Samir Sur, David McCarthy, Alan Stein, Priyank Khandelwal, Robert M Starke, Eric C Peterson
BACKGROUND: Acute ischemic stroke in pregnancy is a cause of maternal and fetal morbidity. Optimal treatment strategies for stroke in this population are undefined. Thrombolysis is recommended by guidelines should the benefit outweigh uterine bleeding risk. Alternately, data regarding mechanical thrombectomy (MT) is extremely limited. We present a 37-year-old female in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access...
September 24, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/30256724/evaluation-of-the-experience-of-spoke-hospitals-in-an-academic-telestroke-network
#8
Rajan Gadhia, Lee H Schwamm, Anand Viswanathan, Cynthia Whitney, Arianna Moreno, Kori S Zachrison
Background/Introduction: Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. We sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use. DESIGN/METHODS: Within our northeastern US telestroke network, we conducted scripted interviews with representatives (stroke coordinators, nurse managers, and emergency physicians) from each of the 15 spoke hospitals connected to a single academic hub hospital...
September 26, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/30249344/pathological-laughter-as-a-symptom-of-middle-cerebral-artery-stroke
#9
Gülden Özel, David Maltête, Romain Lefaucheur
BACKGROUND: Pathological laughter is defined as uncontrollable and inappropriate laughter unrelated to an emotion or a mood. This symptom can reveal a stroke. CASE REPORT: We described the case of a 57-year-old patient who presented to the emergency department 2 h after a sudden onset of left hemiparesis preceded by pathological laughter. The left motor weakness was very discrete and underestimated because of severe behavioral changes, that is, laughter, joviality, and motor restlessness...
September 21, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30244758/stroke-mimics-the-quest-for-leptomeningeal-anastomoses-and-isolated-diffusion-weigthed-mr-signal
#10
Humberto Morales, Marshall Kong
Stroke is caused by occlusion of a medium- or large-sized vessel in the brain. The treatment with either intravenous or intra-arterial thrombolysis is based on an accurate and time-sensitive diagnosis. On clinical and imaging grounds a number of entities-seizures, toxic-metabolic, infectious, or demyelinating diseases-can mimic stroke. Identifying them is paramount as the treatment differs significantly. Prior imaging reviews have focused on the nonterritorial distribution of these mimics. However, some important questions arise here...
October 2018: Seminars in Ultrasound, CT, and MR
https://www.readbyqxmd.com/read/30239360/stroke-mimics-and-chameleons
#11
Solène Moulin, Didier Leys
PURPOSE OF REVIEW: A stroke mimic is a situation in which a diagnosis of stroke at admission is not confirmed, and a stroke chameleon is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient. RECENT FINDINGS: The safety profile of intravenous thrombolysis (IVT) in patients who have stroke mimics is excellent, and intracranial hemorrhages are rare...
September 20, 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/30236416/fast-protocol-for-treating-acute-ischemic-stroke-by-emergency-physicians
#12
Iiro Heikkilä, Hanna Kuusisto, Markus Holmberg, Ari Palomäki
STUDY OBJECTIVE: Thrombolysis with tissue plasminogen activator should occur promptly after ischemic stroke onset. Various strategies have attempted to improve door-to-needle time. Our objective is to evaluate a strategy that uses an emergency physician-based protocol when no stroke neurologist is available. METHODS: This was a retrospective before-after intervention analysis in an urban hospital. Reorganization of the acute ischemic stroke treatment process was carried out in 2013...
September 17, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/30235055/intraosseous-administration-of-tissue-plasminogen-activator-on-a-mobile-stroke-unit
#13
Ritvij Bowry, May Nour, Teresa Kus, Stephanie Parker, Jonathan Stephenson, Jeffrey Saver, James C Grotta, Daniel Ostermayer
Mobile stroke units offer improved time to administration of thrombolytics for ischemic stroke patients. Acquisition of intravenous (IV) access, however, can be challenging in the pre-hospital environment leading to treatment delays. Intraosseous (IO) access is commonly used in the pre-hospital setting for a variety of conditions and may serve as a viable means for tPA (tissue plasminogen activator) administration. We describe 3 cases in which tPA was administered via IO access on a mobile stroke unit as part of the Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services (BEST-MSU) trial...
September 20, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/30233710/effects-of-atrial-fibrillation-on-complications-and-prognosis-of-patients-receiving-emergency-pci-after-acute-myocardial-infarction
#14
Yingchun Zhang, Lingzhi Zhang, Hongzhi Zheng, Hongfen Chen
The effects of atrial fibrillation on complications and prognosis of patients receiving emergency percutaneous coronary intervention after acute myocardial infarction (AMI) were investigated. Eighty AMI patients treated with interventional vascular recanalization in the Affiliated Hospital of Weifang Medical University (Weifang, China) from July 2015 to October 2016 were selected, including 40 patients complicated with atrial fibrillation before operation (control group) and 40 patients without atrial fibrillation before operation (observation group)...
October 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/30223281/effect-of-different-methods-of-administration-of-diltiazem-on-clinical-efficacy-in-patients-with-acute-st-segment-elevation-myocardial-infarction
#15
Lanfang Zhang, Xiaoyong Qi, Xinwei Jia
BACKGROUND The aim of this study was to investigate the optimal route of administration of diltiazem in emergency PCI and to provide the best clinical treatment for ASTEMI patients. MATERIAL AND METHODS A total of 90 patients with ASTEMI treated in our hospital from January 2015 to January 2016 were selected. Prior to thrombus aspiration, a thrombus aspiration catheter was used to perform diltiazem injection at the distal end of the infarct-related artery (IRA). We chose the acute ST-elevation myocardial infarction (ASTEMI) patients treated with direct PCI to compare different administration routes of diltiazem...
September 17, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/30214268/received-care-compared-to-adp-guided-care-of-patients-admitted-to-hospital-with-chest-pain-of-possible-cardiac-origin
#16
Michael Perera, Leena Aggarwal, Ian A Scott, Bentley Logan
Purpose: To assess the extent to which accelerated diagnostic protocols (ADPs), compared to traditional care, identify patients presenting to emergency departments (EDs) with chest pain who are at low cardiac risk and eligible for early ED discharge. Patients and methods: Retrospective study of 290 patients admitted to hospital for further evaluation of chest pain following negative ED workup (no acute ischemic electrocardiogram [ECG] changes or elevation of initial serum troponin assay)...
2018: International Journal of General Medicine
https://www.readbyqxmd.com/read/30213470/-acute-pulmonary-embolism-in-the-emergency-department-what-do-the-guidelines-say
#17
Nicolas Meneveau
The therapeutic strategy of acute pulmonary embolism (PE) is based on risk stratification of early mortality in the emergency department. Anticoagulant therapy should be given to all PE patients as early as possible, and direct oral anticoagulants are expected to replace vitamin K antagonists in the majority of cases. The use of a reperfusion strategy should always be considered in patients with high-risk PE defined as PE with clinical hemodynamic instability. Surgical or percutaneous embolectomy is an alternative in case of contraindication to thrombolytic therapy in these patients...
September 10, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/30213314/-nursing-support-during-thrombolysis-in-the-neurovascular-icu
#18
Sophie Paternotte, Burty Dercy, Jean-Philippe Désilles, Candice Sabben, Perrine Boursin
Intravenous thrombolysis is one of two emergency procedures for ischaemic stroke. Its implementation requires fine coordination of the healthcare team and must be adapted to the local context of each hospital and sector. International good clinical practice guidelines are available to support team organisation.
September 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/30213313/-role-of-pre-hospital-and-hospital-emergency-services-in-the-management-of-stroke
#19
Philippe Lemmel
Any out-of-hospital neurological deficit of less than 24 hours should prompt a call for emergency medical help Urgent Medical Aid Service. Early identification of signs of stroke or transient ischaemic attack allows to guide the therapeutic approach towards intravenous thrombolysis or other alternatives. Telemedicine centres complement the network of neurovascular units.
September 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/30197114/impact-of-code-stroke-on-thrombolytic-therapy-in-patients-with-acute-ischemic-stroke-at-a-secondary-referral-hospital-in-taiwan
#20
Cheng-Lun Hsiao, Yu-Chin Su, Fu-Yi Yang, Chih-Yang Liu, Han-Lin Chiang, Guei-Chiuan Chen, Po-Jen Hsu, Pei-Ya Chen, Shinn-Kuang Lin
BACKGROUND: Efficacy of thrombolytic therapy decreases with time elapsed from symptom onset. We sought to identify the impact of code stroke on the thrombolytic therapy. METHODS: Code stroke is activated by the emergency physician when a patient is eligible for thrombolytic therapy. We retrospectively reviewed patients with acute ischemic stroke between January 2011 and December 2014. RESULTS: In total, 1809 patients were enrolled. Code stroke was activated in 233 of 351 patients arriving at the emergency room (ER) within 3 h of symptom onset, and in 21 patients arriving >3 h...
September 6, 2018: Journal of the Chinese Medical Association: JCMA
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