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By Richard Gough Paramedic tutor, Post Qualification Manager
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Fernando Godinho Zampieri, David Turkel-Parrella, Abhijit Duggal, Thomas R Marotta, R Loch Macdonald, Simon Abrahamson
Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding...
2016: Critical Care: the Official Journal of the Critical Care Forum
Urban Janlert
No abstract text is available yet for this article.
October 31, 2015: Lancet
Katie Tataris, Sean Kivlehan, Prasanthi Govindarajan
INTRODUCTION: The emergency medical services (EMS) system plays a crucial role in the chain of survival for acute myocardial infarction (AMI) and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. METHODS: Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS) dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED) by ambulance...
November 2014: Western Journal of Emergency Medicine
Sofie Amalie Simonsen, Morten Andresen, Lene Michelsen, Søren Viereck, Freddy K Lippert, Helle Klingenberg Iversen
BACKGROUND: Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009. METHODS: We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011...
2014: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Hiroshi Karibe, Toshiaki Hayashi, Takayuki Hirano, Motonobu Kameyama, Atsuhiro Nakagawa, Teiji Tominaga
Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described...
2014: Neurologia Medico-chirurgica
Luiz Carlos Porcello Marrone, João Pedro Farina Brunelli, Ricardo Lutzky Saute, Gustavo Henrique Tomasi, Bianca Cecchele Madeira, William Alves Martins, Robson Dupont Rohr, Ana Paula Heck, Luiz Ricardo Botton, Marilia Martins de Castro, Rodrigo Bodanese, Luiz Carlos Bodanese, Antônio Carlos Huf Marrone, Jaderson Costa da Costa
Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries...
2014: Thrombosis
Darren Flynn, Gary A Ford, Helen Rodgers, Christopher Price, Nick Steen, Richard G Thomson
OBJECTIVE: In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. METHODS: Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charity's information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database...
2014: PloS One
Laetitia Yperzeele, Robbert-Jan Van Hooff, Ann De Smedt, Alexis Valenzuela Espinoza, Rohny Van de Casseye, Ives Hubloue, Jacques De Keyser, Raf Brouns
BACKGROUND: The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice...
2014: Cerebrovascular Diseases
Annika Berglund, Leif Svensson, Nils Wahlgren, Mia von Euler
BACKGROUND: Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service. METHODS: The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h...
2014: Cerebrovascular Diseases
Janet E Bray, Kelly Coughlan, Bill Barger, Chris Bladin
BACKGROUND AND PURPOSE: Recent evidence suggests the Cincinnati Prehospital Stroke Scale is ineffectively used and lacks sensitivity and specificity. Melbourne (Australia) paramedics have been using the Melbourne Ambulance Stroke Screen (MASS) since 2005. The aim of this study was to review the real-world use of MASS 3 years after city wide implementation. METHODS: Two groups of consecutively admitted patients to an Australian hospital between January and May 2008 were used: (1) patients for whom paramedics performed MASS; and (2) patients with a discharge diagnosis of stroke or transient ischemic attack...
July 2010: Stroke; a Journal of Cerebral Circulation
Ramesh Sahathevan, Shahrul Azmin, Sivakumar Palaniappan, Wan Yahya Nafisah, Hui Jan Tan, Mohamed Ibrahim Norlinah, Mukari Shahizon
A young man was admitted with sudden onset of right-sided weakness. He was assessed in the emergency department, and an immediate computed tomography (CT) perfusion study of the brain was arranged, which showed a left middle cerebral artery territory infarct with occlusion of the M1 segment. There was a significant penumbra measuring approximately 50% of the arterial territory. By the time his assessment was completed, it was 5.5 hours from the onset of symptoms. He was nonetheless administered intravenous recombinant tissue plasminogen activator (rtPA) based on the significant penumbra...
March 2014: Malaysian Journal of Medical Sciences: MJMS
Áine Merwick, David Werring
No abstract text is available yet for this article.
2014: BMJ: British Medical Journal
Amre Nouh, Jessica Remke, Sean Ruland
Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens.
2014: Frontiers in Neurology
Sinéad M Langan, Caroline Minassian, Liam Smeeth, Sara L Thomas
BACKGROUND: Herpes zoster is common and vaccine preventable. Stroke risk may be increased following zoster, but evidence is sparse and could be explained by differences between people with and without zoster. Our objective was to determine if stroke risk is increased following zoster. METHODS: Within-person comparisons were undertaken using the self-controlled case-series method and data from the UK Clinical Practice Research Datalink (1987-2012). Participants had a first-ever diagnosis of zoster and stroke within the study period...
June 2014: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Peter A G Sandercock, Carl Counsell, Mei-Chiun Tseng, Emanuela Cecconi
BACKGROUND: In people with acute ischaemic stroke, platelets become activated and can cause blood clots to form and block an artery in the brain, resulting in damage to part of the brain. Such damage gives rise to the symptoms of stroke. Antiplatelet therapy might reduce the volume of brain damaged by ischaemia and also reduce the risk of early recurrent ischaemic stroke, thereby reducing the risk of early death and improving long-term outcomes in survivors. However, antiplatelet therapy might also increase the risk of fatal or disabling intracranial haemorrhage...
2014: Cochrane Database of Systematic Reviews
Massimo Camerlingo, Salvatore D'Asero, Laura Perego, Catiuscia Rovaris, Marcello Tognozzi, Luca Moschini, Giuseppe Galbiati, Emilio Pozzi, Oliviero Valoti
Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners...
September 2014: Neurological Sciences
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