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Stroke prehospital

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https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#1
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29127102/algorithms-to-guide-ambulance-clinicians-in-the-management-of-emergencies-in-patients-with-implanted-rotary-left-ventricular-assist-devices
#2
REVIEW
Christopher T Bowles, Rachel Hards, Neil Wrightson, Paul Lincoln, Shishir Kore, Laura Marley, Jonathan R Dalzell, Binu Raj, Tracey A Baker, Diane Goodwin, Petra Carroll, Jane Pateman, John J M Black, Paul Kattenhorn, Mark Faulkner, Jayan Parameshwar, Charles Butcher, Mark Mason, Alexander Rosenberg, Ian McGovern, Alexander Weymann, Carl Gwinnutt, Nicholas R Banner, Stephan Schueler, Andre R Simon, David W Pitcher
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making...
November 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29123838/prehospital-triage-for-endovascular-clot-removal-in-acute-stroke-patients
#3
Yu Suzuki, Yasuhiro Hasegawa, Kohtaro Tsumura, Toshihiro Ueda, Kazunari Suzuki, Makoto Sugiyama, Hiroyuki Nozaki, Shojiro Kawaguchi, Makoto Nakane, Goro Nagashima, Takayuki Kitamura, Kengo Yokomine, Jinichi Sasanuma
Aim: To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city-wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation. Methods: Kawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs)...
January 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29108809/response-to-symptoms-and-prehospital-delay-in-stroke-patients-is-it-time-to-reconsider-stroke-awareness-campaigns
#4
Rafael García Ruiz, Julia Silva Fernández, Rosa María García Ruiz, Marta Recio Bermejo, Ángel Arias Arias, Pablo Del Saz Saucedo, Rafael Huertas Arroyo, Ana González Manero, Ana Santos Pinto, Santiago Navarro Muñoz, Enrique Botia Paniagua, José Abellán Alemán
BACKGROUND: Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. METHODS: A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded...
November 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29101258/impact-on-prehospital-delay-of-a-stroke-preparedness-campaign-a-sw-rct-stepped-wedge-cluster-randomized-controlled-trial
#5
Licia Denti, Caterina Caminiti, Umberto Scoditti, Andrea Zini, Giovanni Malferrari, Maria Luisa Zedde, Donata Guidetti, Mario Baratti, Luca Vaghi, Enrico Montanari, Barbara Marcomini, Silvia Riva, Elisa Iezzi, Paola Castellini, Silvia Olivato, Filippo Barbi, Eva Perticaroli, Daniela Monaco, Ilaria Iafelice, Guido Bigliardi, Laura Vandelli, Angelica Guareschi, Andrea Artoni, Carla Zanferrari, Peter J Schulz
BACKGROUND AND PURPOSE: Public campaigns to increase stroke preparedness have been tested in different contexts, showing contradictory results. We evaluated the effectiveness of a stroke campaign, designed specifically for the Italian population in reducing prehospital delay. METHODS: According to an SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial) design, the campaign was launched in 4 provinces in the northern part of the region Emilia Romagna at 3-month intervals in randomized sequence...
November 3, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29099343/feasibility-study-of-a-novel-high-flow-cold-air-cooling-protocol-of-the-porcine-brain-using-mri-temperature-mapping
#6
Jan Sedlacik, Åsmund Kjørstad, Zsuzsanna Nagy, Jan-Hendrik Buhk, Christoph R Behem, Constantin J Trepte, Jens Fiehler, Fabian Temme
Early, prehospital cooling seeks to reduce and control the body temperature as early as possible to protect the brain and improve patient outcome in cardiac arrest, stroke, and traumatic brain injury. In this study, we investigate the feasibility of localized cooling of the porcine brain by using a novel high-flow cold air protocol, which utilizes the close proximity between the nasal cavity and the brain. Five adult pigs were anesthetized and temperature change was mapped before, during, and after cooling by using the proton resonance frequency method on a 3 T Siemens Magnetom Skyra system...
November 3, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/29057682/improving-diagnosis-of-childhood-arterial-ischaemic-stroke
#7
Mark T Mackay, Paul Monagle, Franz E Babl
At least half of childhood stroke survivors suffer long-term impairments. Rapid identification of stroke is essential to minimize the extent of injury by restoring perfusion to viable brain. Improving diagnosis of childhood stroke requires correct identification of stroke by prehospital and emergency physicians, rapid performance of appropriate neuroimaging to confirm infarction, and targeted investigations to determine underlying causes, which guide treatment decisions to reduce recurrence risk. Areas covered: This review will summarize the barriers to rapid stroke diagnosis in pre-hospital and emergency department settings, describe recent progress in understanding of the spectrum, presenting clinical features and differential diagnosis of childhood stroke, discuss clinical stroke recognition tools which improve diagnostic accuracy, and their application to children...
November 7, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/29023166/prehospital-stroke-assessment-for-large-vessel-occlusions-a-systematic-review
#8
William Krebs, Travis P Sharkey-Toppen, Fern Cheek, Eric Cortez, Ashley Larrimore, David Keseg, Ashish R Panchal
BACKGROUND AND OBJECTIVE: Stroke is the leading cause of disability in the United States and new evidence shows interventional procedures provide better outcomes for large vessel occlusions (LVO). We performed a systematic review of the literature on prehospital stroke scales used to identify LVOs comparing the scales with analysis of the sensitivity, specificity, and predictive values. The goal was to determine if emergency medical services (EMS) are able to accurately identify LVO in the field...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28976180/magnetic-particle-imaging-for-real-time-perfusion-imaging-in-acute-stroke
#9
Peter Ludewig, Nadine Gdaniec, Jan Sedlacik, Nils D Forkert, Patryk Szwargulski, Matthias Graeser, Gerhard Adam, Michael G Kaul, Kannan M Krishnan, R Matthew Ferguson, Amit P Khandhar, Piotr Walczak, Jens Fiehler, Götz Thomalla, Christian Gerloff, Tobias Knopp, Tim Magnus
The fast and accurate assessment of cerebral perfusion is fundamental for the diagnosis and successful treatment of stroke patients. Magnetic particle imaging (MPI) is a new radiation-free tomographic imaging method with a superior temporal resolution, compared to other conventional imaging methods. In addition, MPI scanners can be built as prehospital mobile devices, which require less complex infrastructure than computed tomography (CT) and magnetic resonance imaging (MRI). With these advantages, MPI could accelerate the stroke diagnosis and treatment, thereby improving outcomes...
October 24, 2017: ACS Nano
https://www.readbyqxmd.com/read/28959230/accuracy-of-emergency-medical-services-dispatcher-and-crew-diagnosis-of-stroke-in-clinical-practice
#10
Judy Jia, Roger Band, Michael E Abboud, William Pajerowski, Michelle Guo, Guy David, C Crawford Mechem, Steven R Messé, Brendan G Carr, Michael T Mullen
BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28939567/association-between-gender-and-short-term-outcome-in-patients-with-st-elevation-myocardial-infraction-participating-in-the-international-prospective-randomised-administration-of-ticagrelor-in-the-catheterisation-laboratory-or-in-the-ambulance-for-new-st-elevation
#11
Dimitrios Venetsanos, Sofia Sederholm Lawesson, Joakim Alfredsson, Magnus Janzon, Angel Cequier, Mohamed Chettibi, Shaun G Goodman, Arnoud W Van't Hof, Gilles Montalescot, Eva Swahn
OBJECTIVES: To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). SETTINGS: A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. PARTICIPANTS: Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included...
September 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28936069/prehospital-management-of-acute-stroke-in-rural-versus-urban-responders
#12
Gregory Hansen, Simerpreet Bal, Kerri Lynn Schellenberg, Susan Alcock, Esseddeeg Ghrooda
OBJECTIVE: Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center. MATERIALS AND METHODS: One hundred adult patients were randomly selected from the stroke registry. Patients were transported through Rural EMS bypass protocols or urban EMS protocols (both bypass and direct) to our stroke center between January and December 2013...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28910463/use-of-acetylsalicylic-acid-in-the-prehospital-setting-for-suspected-acute-ischemic-stroke
#13
John M Levri, Armando Ocon, Paul Schunk, Cord W Cunningham
Acute ischemic stroke (AIS) treatment guidelines include various recommendations for treatment once the patient arrives at the hospital. Prehospital care recommendations, however, are limited to expeditious transport to a qualified hospital and supportive care. The literature has insufficiently considered prehospital antiplatelet therapy. An otherwise healthy 30-year-old black man presented with headache for about 3 hours, left-sided facial and upper extremity numbness, slurred speech, miosis, lacrimation, and general fatigue and malaise...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28900664/-prehospital-care-for-stroke-patients
#14
REVIEW
C H Nolte, H J Audebert
The effectiveness of thrombolysis or mechanical recanalization for acute stroke is higher, the sooner these therapies are started. Therefore, acute stroke patients need to be evaluated by qualified staff for these therapies as soon as possible. Lay persons need to identify the typical symptoms of stroke as an emergency and act accordingly by calling the emergency medical system (EMS). The EMS team reassesses the symptoms and prompts cerebral imaging. Cerebral imaging is performed ideally in hospitals with a stroke unit where subsequent (stroke) treatments occur...
November 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28887388/minocycline-in-acute-cerebral-hemorrhage-an-early-phase-randomized-trial
#15
RANDOMIZED CONTROLLED TRIAL
Abdelrahman Y Fouda, Andrea S Newsome, Samantha Spellicy, Jennifer L Waller, Wenbo Zhi, David C Hess, Adviye Ergul, David J Edwards, Susan C Fagan, Jeffrey A Switzer
BACKGROUND AND PURPOSE: Minocycline is under investigation as a neurovascular protective agent for stroke. This study evaluated the pharmacokinetic, anti-inflammatory, and safety profile of minocycline after intracerebral hemorrhage. METHODS: This study was a single-site, randomized controlled trial of minocycline conducted from 2013 to 2016. Adults ≥18 years with primary intracerebral hemorrhage who could have study drug administered within 24 hours of onset were included...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28878305/effects-of-intensive-blood-pressure-reduction-on-acute-intracerebral-hemorrhage-a-systematic-review-and-meta-analysis
#16
Shun Gong, Chao Lin, Danfeng Zhang, Xiangyi Kong, Jigang Chen, Chunhui Wang, Zhenxing Li, Rongbin Chen, Ping Sheng, Yan Dong, Lijun Hou
Current opinions about the effect of intensive blood pressure (BP) reduction for acute intracerebral hemorrhage (ICH) are inconsistent. We performed a meta-analysis to evaluate the efficacy and safety of intensive BP reduction for acute ICH by analyzing data from several recent randomized controlled trials (RCTs). There were six eligible studies that met the inclusion criteria, for a total of 4,385 acute ICH patients in this meta-analysis. After analyzing these data, we found differences between intensive and standard BP lowering treatment groups in total mortality rates, unfavorable outcomes, hematoma expansion, neurologic deterioration, and severe hypotension were not significant...
September 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28864702/design-and-validation-of-a-clinical-scale-for-prehospital-stroke-recognition-severity-grading-and-prediction-of-large-vessel-occlusion-the-shortened-nih-stroke-scale-for-emergency-medical-services
#17
Jan Christoph Purrucker, Florian Härtig, Hardy Richter, Andreas Engelbrecht, Johannes Hartmann, Jonas Auer, Christian Hametner, Erik Popp, Peter Arthur Ringleb, Simon Nagel, Sven Poli
OBJECTIVE: To develop an NIH Stroke Scale (NIHSS)-compatible, all-in-one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO). METHODS: Emergency medical services (EMS) personnel and stroke physicians (n=326) rated each item of the NIHSS regarding suitability for prehospital use; best rated items were included. Stroke recognition was evaluated retrospectively in 689 consecutive patients with acute stroke or stroke mimics, prediction of LVO in 741 consecutive patients with ischaemic stroke with acute vessel imaging independent of admission NIHSS score...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28804875/prehospital-pathways-of-occipital-stroke-patients-with-mainly-visual-symptoms
#18
S Räty, K Silvennoinen, T Tatlisumak
OBJECTIVES: Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition...
August 13, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28766306/interpretation-of-brain-ct-scans-in-the-field-by-critical-care-physicians-in-a-mobile-stroke-unit
#19
Maren Ranhoff Hov, Erik Zakariassen, Thomas Lindner, Terje Nome, Kristi G Bache, Jo Røislien, Jostein Gleditsch, Volker Solyga, David Russell, Christian G Lund
BACKGROUND AND PURPOSE: In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU)...
July 27, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28745691/-causal-relationships-in-stroke-and-kidney-injury
#20
A M Gerdt, A M Shutov, M V Menzorov, E A Gubareva
AIM: To assess the frequency, severity, and causes of acute kidney injury (AKI) in patients with stroke. SUBJECTS AND METHODS: 272 patients (143 men and 129 women) (mean age, 66.7±11.6 years) with stroke were examined. The 2008 European Stroke Organization (ESO) guidelines were used to diagnose stroke, to determine indications for and contraindications to thrombolytic therapy, and to evaluate its efficiency. Hemorrhagic and ischemic strokes (HS and IS) were diagnosed in 52 (19%) and 220 (81%) patients, respectively...
2017: Terapevticheskiĭ Arkhiv
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