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Stroke prehospital

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https://www.readbyqxmd.com/read/27894558/helicopter-scene-response-for-stroke-patients-a-5-year-experience
#1
Andrew Hawk, Catherine Marco, Matt Huang, Bonnie Chow
OBJECTIVE: The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. METHODS: CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27834751/stroke-thrombolysis-in-a-centralized-and-a-decentralized-system-helsinki-and-telemedical-project-for-integrative-stroke-care-network
#2
Gordian J Hubert, Atte Meretoja, Heinrich J Audebert, Turgut Tatlisumak, Florian Zeman, Sandra Boy, Roman L Haberl, Markku Kaste, Peter Müller-Barna
BACKGROUND AND PURPOSE: Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. METHODS: We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27827326/cutting-the-prehospital-on-scene-time-of-stroke-thrombolysis-in-helsinki-a-prospective-interventional-study
#3
Tuukka Puolakka, Markku Kuisma, Sami Länkimäki, Jyrki Puolakka, Juhana Hallikainen, Kirsi Rantanen, Perttu J Lindsberg
BACKGROUND AND PURPOSE: Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration. METHODS: In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department...
November 8, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27822599/prehospital-and-intra-hospital-time-delays-in-posterior-circulation-stroke-results-from-the-austrian-stroke-unit-registry
#4
Peter Sommer, Leonhard Seyfang, Alexandra Posekany, Julia Ferrari, Wilfried Lang, Elisabeth Fertl, Wolfgang Serles, Thomas Töll, Stefan Kiechl, Stefan Greisenegger
Therapeutic effect of recombinant tissue-plasminogen activator (rt-PA) is time dependent. There is limited evidence whether localization of stroke within the posterior circulation (PCS) is associated with a treatment delay. We aimed to analyze within a nationwide multicenter cohort whether duration of pre- and intra-hospital patient management differs between patients with PCS and anterior circulation strokes (ACS). We studied onset-to-door-times (ODT) and door-to-needle-times (DNT) of all patients with acute ischemic stroke (IS) enrolled in the Austrian Stroke Unit Registry according to infarct localization...
November 7, 2016: Journal of Neurology
https://www.readbyqxmd.com/read/27818120/efficacy-and-safety-of-prehospital-administration-of-unfractionated-heparin-enoxaparin-or-bivalirudin-in-patients-undergoing-primary-percutaneous-coronary-intervention-for-st-segment-elevation-myocardial-infarction-insights-from-the-orbi-registry
#5
Vincent Auffret, Guillaume Leurent, Dominique Boulmier, Marc Bedossa, Amer Zabalawi, Jean-Philippe Hacot, Isabelle Coudert, Emmanuelle Filippi, Philippe Castellant, Antoine Rialan, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marielle Le Guellec, Martine Gilard, Hervé Le Breton
BACKGROUND: Despite numerous studies in recent years, the best anticoagulant option for primary percutaneous coronary intervention (PCI) remains a matter of debate. AIMS: To compare in-hospital outcomes after prehospital administration of low-dose unfractionated heparin (UFH)±glycoprotein IIb/IIIa inhibitors (GPIs), enoxaparin±GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1720 patients (median age 62...
November 3, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27814743/prehospital-fibrinolysis-versus-primary-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#6
Vincent Roule, Pierre Ardouin, Katrien Blanchart, Adrien Lemaitre, Julien Wain-Hobson, Damien Legallois, Joachim Alexandre, Rémi Sabatier, Paul Milliez, Farzin Beygui
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. RESULTS: Compared with PPCI, FL was consistently associated with similar rates of short-term (30-90 days) death (relative risk [RR] 0...
November 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27741992/treatment-of-acute-ischemic-stroke
#7
Matthew S Siket
Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration-approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741991/diagnosis-of-acute-ischemic-stoke
#8
Lauren M Nentwich
Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27720525/predictive-value-of-modifications-of-the-prehospital-rapid-arterial-occlusion-evaluation-scale-for-large-vessel-occlusion-in-patients-with-acute-stroke
#9
David Carrera, Bruce C V Campbell, Jordi Cortés, Montse Gorchs, Marisol Querol, Xavier Jiménez, Mònica Millán, Antoni Dávalos, Natalia Pérez de la Ossa
BACKGROUND: Prehospital clinical scales to identify patients with acute stroke with a large vessel occlusion (LVO) and direct them to an endovascular-capable stroke center are needed. We evaluated whether simplification of the Rapid Arterial oCclusion Evaluation (RACE) scale, a 5-item scale previously validated in the field, could maintain its high performance to identify patients with LVO. METHODS: Using the original prospective validation cohort of the RACE scale, 7 simpler versions of the RACE scale were designed and retrospectively recalculated for each patient...
October 6, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27707873/prehospital-care-delivery-and-triage-of-stroke-with-emergent-large-vessel-occlusion-elvo-report-of-the-standards-and-guidelines-committee-of-the-society-of-neurointerventional-surgery
#10
G Lee Pride, Justin F Fraser, Rishi Gupta, Mark J Alberts, J Neal Rutledge, Ray Fowler, Sameer A Ansari, Todd Abruzzo, Barb Albani, Adam Arthur, Blaise Baxter, Ketan R Bulsara, Michael Chen, Josser E Delgado Almandoz, Chirag D Gandhi, Don Heck, Steven W Hetts, Joshua A Hirsch, M Shazam Hussain, Richard Klucznik, Seon-Kyu Lee, William J Mack, Thabele Leslie-Mazwi, Ryan A McTaggart, Philip M Meyers, J Mocco, Charles Prestigiacomo, Athos Patsalides, Peter Rasmussen, Robert M Starke, Peter Sunenshine, Donald Frei, Mahesh V Jayaraman
No abstract text is available yet for this article.
October 5, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27693052/prehospital-and-in-hospital-course-of-care-for-patients-with-acute-heart-failure-features-and-impact-on-prognosis-in-real-life
#11
Laura Cluzol, Jennifer Cautela, Pierre Michelet, Antoine Roch, François Kerbaul, Julien Mancini, Marc Laine, Michael Peyrol, Floriane Robin, Franck Paganelli, Laurent Bonello, Franck Thuny
BACKGROUND: Acute heart failure (AHF) is a life-threatening medical emergency for which no new effective therapies have emerged in recent decades. No previous study has exhaustively described the entire course of care of AHF patients from first medical contact to hospital discharge or assessed its impact on prognosis. AIM: To fully describe the course of care and analyze its influence on outcomes in patients hospitalized with an AHF syndrome in an academic university center...
September 29, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27679533/characteristics-and-outcomes-of-very-elderly-enrolled-in-a-prehospital-stroke-research-study
#12
Nerses Sanossian, Kathleen C Apibunyopas, David S Liebeskind, Sidney Starkman, Adrian M Burgos, Robin Conwit, Marc Eckstein, Frank Pratt, Sam Stratton, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: Greater numbers of individuals aged ≥80 years enjoy a high quality of life, yet historically stroke trials have excluded this population. We aimed to describe a population of very elderly successfully enrolled into an acute stroke trial and compare their characteristics and outcomes with the younger cohort. METHODS: We analyzed consecutive patients enrolled <2 hours of symptom onset in a prehospital stroke treatment trial, the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium)...
November 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27642014/ultra-acute-diagnostics-for-stroke-large-scale-implementation-of-prehospital-biomarker-sampling
#13
O S Mattila, H Harve, S Pihlasviita, J Ritvonen, G Sibolt, M Pystynen, D Strbian, S Curtze, M Kuisma, T Tatlisumak, P J Lindsberg
OBJECTIVES: Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. MATERIALS AND METHODS: Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique...
September 18, 2016: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/27608817/parental-care-seeking-behavior-and-prehospital-timelines-of-care-in-childhood-arterial-ischemic-stroke
#14
Mark T Mackay, Belinda Stojanovski, Ian Mosley, Leonid Churilov, Geoffrey A Donnan, Paul Monagle
BACKGROUND AND PURPOSE: Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS: A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014...
October 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27469579/analysis-of-the-new-code-stroke-protocol-in-asturias-after-one-year-experience-at-one-hospital
#15
C García-Cabo, L Benavente, J Martínez-Ramos, Á Pérez-Álvarez, A Trigo, S Calleja
INTRODUCTION: Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias. PATIENTS AND METHODS: We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year...
July 25, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/27411494/pre-hospital-delay-and-its-associated-factors-in-first-ever-stroke-registered-in-communities-from-three-cities-in-china
#16
Bin Jiang, Xiaojuan Ru, Haixin Sun, Hongmei Liu, Dongling Sun, Yunhai Liu, Jiuyi Huang, Li He, Wenzhi Wang
This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27377636/diagnosis-and-mortality-in-prehospital-emergency-patients-transported-to-hospital-a-population-based-and-registry-based-cohort-study
#17
Erika Frischknecht Christensen, Thomas Mulvad Larsen, Flemming Bøgh Jensen, Mette Dahl Bendtsen, Poul Anders Hansen, Søren Paaske Johnsen, Christian Fynbo Christiansen
OBJECTIVE: Knowledge about patients after calling for an ambulance is limited to subgroups, such as patients with cardiac arrest, myocardial infarction, trauma and stroke, while population-based studies including all diagnoses are few. We examined the diagnostic pattern and mortality among all patients brought to hospital by ambulance after emergency calls. DESIGN: Registry-based cohort study. SETTING AND PARTICIPANTS: We included patients brought to hospital in an ambulance dispatched after emergency calls during 2007-2014 in the North Denmark Region (580 000 inhabitants)...
2016: BMJ Open
https://www.readbyqxmd.com/read/27364531/field-assessment-stroke-triage-for-emergency-destination-a-simple-and-accurate-prehospital-scale-to-detect-large-vessel-occlusion-strokes
#18
Fabricio O Lima, Gisele S Silva, Karen L Furie, Michael R Frankel, Michael H Lev, Érica C S Camargo, Diogo C Haussen, Aneesh B Singhal, Walter J Koroshetz, Wade S Smith, Raul G Nogueira
BACKGROUND AND PURPOSE: Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. METHODS: The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset...
August 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27348228/dispatcher-stroke-recognition-using-a-stroke-screening-tool-a-systematic-review
#19
John Adam Oostema, Trevor Carle, Nadine Talia, Mathew Reeves
BACKGROUND: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy...
2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27328702/influence-of-distance-to-scene-on-time-to-thrombolysis-in-a-specialized-stroke-ambulance
#20
Peter M Koch, Alexander Kunz, Martin Ebinger, Frederik Geisler, Michal Rozanski, Carolin Waldschmidt, Joachim E Weber, Matthias Wendt, Benjamin Winter, Katja Zieschang, Kerstin Bollweg, Sabina Kaczmarek, Matthias Endres, Heinrich J Audebert
BACKGROUND AND PURPOSE: Specialized computed tomography-equipped stroke ambulances shorten time to intravenous thrombolysis in acute ischemic stroke by starting treatment before hospital arrival. Because of longer travel-time-to-scene, time benefits of this concept are expected to diminish with longer distances from base station to scene. METHODS: We used data from the Prehospital Acute Neurological Treatment and Optimization of Medical Cares in Stroke (PHANTOM-S) trial comparing time intervals between patients for whom a specialized stroke ambulance (stroke emergency mobile) was deployed and patients with conventional emergency medical service...
August 2016: Stroke; a Journal of Cerebral Circulation
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