Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,724 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label emergency room doctors. Show all posts
Showing posts with label emergency room doctors. Show all posts
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Abstract
Recent
positive trials have thrust acute cerebral perfusion imaging into the
routine evaluation of acute ischemic stroke. Updated guidelines state
that in patients with anterior circulation large vessel occlusions
presenting beyond 6 hours from time last known well, advanced imaging
selection including perfusion-based selection is necessary. Centers that
receive patients with acute stroke must now have the capability to
perform and interpret CT or magnetic resonance perfusion imaging or
provide rapid transfer to centers with the capability of selecting
patients for a highly impactful endovascular therapy, particularly in
delayed time windows. Many stroke centers are quickly incorporating the
use of automated perfusion processing software to interpret perfusion
raw data. As CT perfusion (CTP) is being assimilated in real-world
clinical practice, it is essential to understand the basics of perfusion
acquisition, quantification, and interpretation. It is equally
important to recognize the common technical and clinical diagnostic
challenges of automated CTP including ischemic core and penumbral
misclassifications that could result in underestimation or
overestimation of the core and penumbra volumes. This review highlights
the pitfalls of automated CTP along with practical pearls to address the
common challenges. This is particularly tailored to aid the acute
stroke clinician who must interpret automated perfusion studies in an
emergency setting to make time-dependent treatment decisions for
patients with acute ischemic stroke.
Guidelines for the primary prevention of stroke recognize the emergency department
as a location for physicians to identify atrial fibrillation and to initiate oral
anticoagulants. Numerous studies have shown low anticoagulant prescription rates—approximately
18%—in OAC-naïve patients with atrial fibrillation discharged from the emergency department.
We sought to obtain the opinions of Emergency Medicine physicians regarding anticoagulant
decision-making for patients with atrial fibrillation seen in the emergency department.
Methods
14-item paper surveys were distributed to emergency department physicians within a
single hospital system. The survey consisted of single-, multi- answer and open-ended
questions regarding knowledge and usage frequency of the CHA
2DS
2-VASc score, knowledge of anticoagulant options and reasons for why an anticoagulant
was not initiated.
Results
55 emergency department physicians completed the survey (overall response rate 59%).
89% (49/55) agreed the emergency department is an important location to initiate anticoagulation
depending on comorbidities. A lower proportion reported ever starting a patient in
the emergency department on a new anticoagulant prescription upon discharge (55% (30/55)
p <.0001). The belief that a new anticoagulant prescription is the responsibility of
the PCP/ Cardiologist/ Neurologist (52%; 15/29), not wanting to be held responsible
in the event of a life-threatening bleeding event (41%; 12/29), and concerns about
inadequate follow-up and/or lack of insurance (24%; 7/29) were the most commonly cited
reasons for not starting an appropriate patient with atrial fibrillation on an anticoagulant.
Conclusion
Emergency Medicine physicians support initiating oral anticoagulants in the ED for
patients with atrial fibrillation; however, discrepancies exist between their intentions
and actual practice.
You better hope your emergency room doctors are trained in this, especially for young adult strokes. Or you will need to demand an eye scan in the ER. Hope you are coherent enough to know how to challenge ER doctors on their expertise. Personally I'd prefer these much faster and objective ways of stroke determination, but then I know nothing, I'm not medically trained.
We
evaluated the frequency and predictive value of ocular fundus
abnormalities among patients who presented to the emergency department
(ED) with focal neurologic deficits to determine the utility of these
findings in the evaluation of patients with suspected TIA and stroke.
Methods:
In
this cross-sectional pilot study, ocular fundus photographs were
obtained using a nonmydriatic fundus camera. Demographic, neuroimaging,
and ABCD2 score components were collected. Photographs were
reviewed for retinal microvascular abnormalities. The results were
analyzed using univariate statistics and logistic regression modeling.
Results:
Two
hundred fifty-seven patients presented to the ED with focal neurologic
deficits, of whom 81 patients (32%) had cerebrovascular disease (CVD)
and 144 (56%; 95% confidence interval: 50%–62%) had retinal
microvascular abnormalities. Focal and general arteriolar narrowing
increased the odds of clinically diagnosed CVD by 5.5 and 2.6 times,
respectively, after controlling for the ABCD2 score and
diffusion-weighted imaging. These fundus findings also significantly
differentiated TIA from non-CVD, even after controlling for the ABCD2 score.
Conclusions:
Focal
and general arteriolar narrowing were independent predictors of CVD
overall, and TIA alone, even after controlling for the ABCD2
score and diffusion-weighted imaging lesions. The inclusion of
nonmydriatic ocular fundus photographs in the evaluation of patients
presenting to the ED with focal neurologic deficits may assist in the
differentiation of stroke and TIA from other causes of focal neurologic
deficits.
Annually in the United States, 200,000 to 500,000 patients experience TIA,1 with 7% to 14% subsequently having a stroke within 90 days.2 A number of scores, particularly the widely used ABCD2 score, were developed to determine which patients with TIA have the highest risk of stroke.2 However, these scores have serious limitations.3,–7 Diffusion-weighted imaging (DWI) has revolutionized the differentiation of stroke from TIA.1
However, a negative DWI does not assist with the difficult, and
arguably more important, task of differentiating TIA from
non–cerebrovascular diseases, and TIA diagnosis remains very
challenging. About 30% to 50% of patients diagnosed with suspected TIA
by non neurologists are ultimately determined not to have a TIA by a
stroke neurologist.8,9 Even among non stroke neurologists, agreement about TIA is only moderate to good.10
Epidemiologic
investigations have shown an association between ocular fundus
abnormalities and diabetes, cardiovascular disease, and stroke,11,–17
suggesting that ocular funduscopic findings may be useful in the
diagnosis of TIA and stroke in patients who present to the emergency
department (ED) with focal neurologic deficits. Nonmydriatic fundus
cameras can be used to assess for abnormalities of the ocular fundus,
and the cameras are compact, easy to use, and do not require pupillary
dilation, making them an ideal tool for non ophthalmologists. We
undertook a pilot investigation to evaluate the role of ocular fundus
abnormalities in TIA and stroke diagnosis using patients who presented
to our ED with focal neurologic deficits during the Fundus Photography
vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED)
Study.
What the fuck did you do with those that failed the checklist? It is still your responsibility to get them 100% recovered. This checklist use assumes that IT IS YOUR RESPOSIBILITY to have the correct external signs of a stroke. Hope your know that before you get to the ER. 60 patients are not enough to validate this, I don't know what is but that is why you employ a statistician.
Why would you do a checklist at all when these extremely fast diagnosis options are available?
There
is uncertainty among many emergency medicine physicians about the
decision to give intravenous tPA (tissue-type plasminogen activator),
which limits its use. A checklist approach has been suggested as a
solution. We compared agreement on tPA treatment in suspected acute
ischemic stroke patients between emergency medicine residents (EMRs)
using a checklist and vascular neurology fellows (VNFs).
Methods—
Every
suspected acute stroke patient brought to our comprehensive stroke
center emergency room within 4.5 hours from symptom onset was
prospectively evaluated simultaneously and independently by VNFs and
EMRs. The latter used a tPA screening checklist, which included
guideline exclusion criteria to help with their treatment decision.
Agreement was determined using kappa (k) statistics.
Results—
Over
6 months, 60 patients were enrolled; 10% large vessel atherosclerosis,
18% cardioembolism, 12% small vessel, 12% cryptogenic, and 47% mimic.
Forty-two percent were deemed tPA eligible by the EMR, 30% by the VNF,
and 37% by the vascular neurology faculty. There were no complications
in any tPA-treated patients(But did ANY of then get 100% RECOVERED? If not them your treatment failed.). Agreement was substantial between EMR and
VNF (κ=0.68 [95% CI, 0.49–0.87]) and between EMR and vascular neurology
faculty (κ=0.69 [95% CI, 0.50–0.87]). Stroke mimics were the main cause
of disagreement between EMR and VNF (κ=0.24 [95% CI, −0.15 to 0.63]) and
between EMR and vascular neurology faculty (κ=0.35 [95% CI, −0.08 to
0.78]).
Conclusions—
Our
data suggest that with the aid of a checklist,(How fast is it? Faster than 90 seconds?) EMRs can accurately
treat stroke patients with tPA. Areas for improvement include
recognition of stroke mimics. Further studies are warranted to evaluate
checklist-enhanced tPA treatment to allay emergency medicine physician
uncertainty and expand the use of tPA.
Correspondence
to Ketevan Berekashvili, MD, Department of Neurology, NYU Langone
Health–Brooklyn, 150 55th St, 3667, Brooklyn, NY 11220. Email ketevan.berekashvili@nyulangone.org
NARIC Accession Number: I243296. What's this? Author(s):H.C. Diener ; B. Frank; K. Hajjar ; C. Weimar. Publication Year: 2014. Abstract: This article provides an overview of new
treatment options in stroke medicine. Systemic thrombolysis with
recombinant tissue-type plasminogen activator (rt-PA) remains the only
effective and approved medical treatment of acute ischemic stroke.
Several studies have demonstrated the importance of rapid
recanalization. The efficacy of thrombectomy has so far not been
sufficiently shown in randomized clinical trials; therefore, inclusion
of suitable patients in one of the currently ongoing randomized trials
is of great importance. The early treatment with magnesium after acute
ischemic stroke during the pre-hospital phase did not prove to be
neuroprotective. Intermittent pneumatic compression of the lower
extremities in immobilized stroke patients effectively prevents deep
venous thrombosis and pulmonary embolism. In patients with lacunar
stroke, the combination of aspirin and clopidogrel is not superior to
aspirin alone and causes more bleeding complications. The novel oral
anticoagulants are superior to warfarin in secondary prevention and
carry a lower risk of intracranial and systemic bleeding complications.
New studies will investigate whether dabigatran or rivaroxaban are
superior to aspirin in secondary prevention after cryptogenic stroke. Descriptor Terms: Clinical trials, Drugs, Stroke. Language: German Geographic Location(s): Europe, Germany.
Citation: H.C. Diener , B. Frank, K. Hajjar , C. Weimar. (2014). New aspects of stroke medicine.
Neues aus der Schlaganfallmedizin.
Der Nervenarzt, 85(8), Pgs. 939-945. Retrieved 8/10/2017, from REHABDATA database.
My definition of cup is certainly not 8 oz. There are too many health benefits of coffee for me to even consider limiting my intake. Read my 129 posts on coffee or 63 posts on caffeinefor details. Or you could just ask your knowledgeable doctor for advice. How many references does your doctor point to to back up her recommendation? Is your emergency room doctor applying this from May, 2014?
For people with severe brain injuries, the rhythm of daily
fluctuations in body temperature is related to their level of
consciousness, according to a study published in the April 19, 2017,
online issue of the journal Neurology.
“Our study suggests that the closer the body temperature patterns of a
severely brain injured person are to those of a healthy person’s
circadian rhythm, the better they scored on tests of recovery from coma,
especially when looking at arousal, which is necessary for
consciousness,” said Christine Blume, PhD, University of Salzburg,
Salzburg, Austria.
In healthy people, daily variations in body temperature closely
follow the sleep-wake cycle. Other studies have found that disruptions
to the sleep-wake cycle may affect various aspects of health like the
immune system and short-term memory. During a normal sleep-wake cycle,
the body’s core temperature fluctuates and can drop 1 to 2 degrees
during the early morning hours.
For the current study, researchers monitored 18 people with severe
brain injuries, those with unresponsive wakefulness syndrome and those
in a minimally conscious state. For 1 week, researchers continually
monitored the body temperatures of participants with external skin
sensors. With that temperature data, they were able to determine the
length of the circadian rhythm for each person. Length of temperature
cycles of participants ranged from 23.5 to 26.3 hours.
The researchers also evaluated the level of consciousness for each
person with the Coma Recovery Scale-Revised, measuring things like
response to sound and ability to open eyes with or without stimulation.
They found that those who scored better on that scale had body
temperature patterns that more closely aligned with a healthy 24-hour
rhythm.
“This is the first time an association has been found between
circadian variations in body temperature and arousal in brain-injured
patients,” said Dr. Blume. “Importantly, arousal is essential for
consciousness. Circadian variations are something doctors should keep in
mind when diagnosing patients. The time of the day when patients are
tested could be crucial. Also, doctors may want to consider creating
environments for patients that mimic the light patterns of night and day
to help achieve a normal sleep-wake cycle. The hope is that this may
help bring a person with a severe brain injury closer to consciousness.”
The researchers tested bright light stimulation on 8 participants for
1 week and found positive effects in 2 patients. Dr. Blume said that
larger studies are needed to test the hypothesis that bright light is
indeed beneficial for patients.
One limitation of the study was that magnetic resonance imaging data
was not available to evaluate the extent of brain damage, especially in
the hypothalamus, the portion of the brain where the body clock is
located.
Dr. Blume suggests that future studies look at the relationship
between body temperature rhythms and other body rhythms like hormone
patterns and rest-activity cycles.
SOURCE: American Academy of Neurology
Just in case you are on this instead of warfarin, you will need to be lucid enough in the emergency room to tell your doctors what anti-clotting drug you are on. https://www.medpagetoday.com/Blogs/EPMonthly/64573?
Agent now available for reversing new oral anticoagulant in bleeding patients
by MedPage Today Staff
A 67-year-old woman is brought in by
EMS after she developed a severe headache at home with associated
vomiting and altered mental status. Her past medical history is
significant for hypertension and atrial fibrillation, for which she
takes atenolol and dabigatran (Pradaxa). The patient is somnolent, and
after quickly securing her airway, you send her for a stat head CT. The
CT shows an intraparenchymal hemorrhage. After paging your neurosurgeon
on call, you consider your options for reversal of anticoagulation. You
know you need to reverse her anticoagulation, but how?
The new oral anticoagulants (NOACs) are skyrocketing in popularity,
displacing warfarin as first-line anticoagulants for many patients.
Dabigatran is a direct thrombin inhibitor used for stroke prevention in
patients with atrial fibrillation and for treatment and secondary
prevention of venous thromboembolism. Dabigatran and other NOACs
have several advantages over warfarin. Their pharmacokinetics are
simpler, they don't have the pesky food and drug interactions that
plague warfarin, they don't require monitoring and frequent dose
adjustments, and importantly, they carry a lower risk of major bleeding complications.
However, a major concern is that unlike warfarin, which can be reversed with Prothrombin Complex Concentrates (PCC)
or fresh frozen plasma and vitamin K, dabigatran and the other NOACs
lacked a dedicated reversal agent. This made emergency physicians and
others who anticipate worst-case scenarios somewhat nervous. Although
the NOACs are associated with fewer serious bleeding complications than
warfarin, life-threatening bleeding can still occur. How should we
manage the patient on dabigatran with an intracranial hemorrhage? Or the
trauma patient who requires emergent surgery for their liver laceration
who happens to be on dabigatran? Alternative reversal methods
have been proposed, such as use of three- or four-factor PCC, fresh
frozen plasma, or even emergent hemodialysis to remove circulating
anticoagulant. However, the efficacy of these methods has been
questioned, and safety concerns have been raised regarding thrombotic
risk of PCC.
In October 2015 the U.S FDA approved a target-specific reversal agent
for dabigatran. Idarucizumab, marketed as Praxbind, is a monoclonal
antibody fragment (Fab) that binds directly to dabigatran, neutralizing
its activity. It is approved for reversal of anticoagulation in patients
on dabigatran requiring emergent or urgent surgery or in patients with
life-threatening bleeding. Dabigatran inhibits thrombin, which catalyzes
one of the final steps in the clotting cascade. Idarucizumab
reverses dabigatran's anticoagulant effects by binding tightly to
dabigatran with an affinity 350 times greater than thrombin, thus
freeing thrombin's functionality in the clotting cascade.
Studies show that administration of idarucizumab to healthy young
volunteers, older volunteers ages 65-80, and volunteers ages 45-80 with
mild or moderate renal impairment resulted in complete reversal of
dabigatran's anticoagulant effects within minutes without any
procoagulant effects. This reversal of anticoagulation lasts 24 hours,
which is an advantage over PCC, which has more transient effects. One
important caveat is that there must be dabigatran in the bloodstream for
idarucizumab to have any effect. Once the dabigatran is cleared by the
kidney, idarucizumab will have nothing to bind to and will have no
effect. It is recommended to give it if the last dose of dabigatran was
in the last 24-48 hours. There may be some benefit of longer time frames
in patients with renal failure, who will have a slower clearance rate
of the dabigatran. Finally, since it is a monoclonal antibody, it is
highly specific for dabigatran. It will not reverse the anticoagulant
effects of coumadin, plavix, or other NOACs such as rivaroxaban.
The data on idarucizumab in patients who are actually bleeding or being operated on looks favorable as well. The Reversal Effects of Idarucizumab on Active Dabigatran (RE-VERSE AD)
trial, a large international prospective cohort study of patients on
dabigatran who receive idarucizumab either for serious bleeding or prior
to an urgent surgical procedure, is still ongoing. A preliminary
analysis of the first 90 patients revealed that idarucizumab rapidly and
completely restored coagulation parameters in 88-98% of patients who
had elevated clotting times at baseline. Among patients who underwent
surgery, normal hemostasis was reported in 92%, with mild to moderate
impairment in 8%. Only one of 90 patients (1%) had a thrombotic event
within 72 hours of administration of idarucizumab. These data mirror the
safety and efficacy data on idarucizumab from earlier human and animal
studies. Dosing
The
FDA-approved dose for idarucizumab is 5 mg, which is administered as
two separate 2.5 mg IV doses infused over 5 minutes. The second dose
should be administered within 15 minutes of the first infusion. There is
no dosing change needed for renal or hepatic impairment. Adverse Events
Adverse reactions are rare and include headache (5%) and hypokalemia
(7%). There are case reports of serious complications in patients
receiving idarucizumab, including acute ischemic stroke, cardiac arrest,
NSTEMI, DVT, and PE, but the incidence is thought to be extremely low. Cautions
Contraindications include hypersensitivity to idarucizumab or any
components of the formulation. Risks/benefits of anticoagulation should
be considered before reversing anticoagulation with idarucizumab, since
the underlying disease state may predispose to thrombotic events.
However, since it is typically reserved for life-threatening bleeds, the
scale typically would favor its use. Cost is also a consideration. Not
all emergency departments may be able to stock idarucizumab due to the
infrequent need for it and its cost. Pregnancy
There are no studies of human or animal models of pregnancy. It is unknown if idarucizumab is excreted in breast milk. Cost
A single 2.5 mg/50 mL dose of idarucizumab costs $2,100, so
recommended treatment with two doses costs $4,200. This is slightly
cheaper than four-factor PCC, which costs about $5,000 for an 80 kg
patient. Karen Serrano, MD, and Christina Shenvi, MD, are assistant
professors of emergency medicine at the University of North Carolina.
Shenvi authors RX Pad each month in EPM. A version of this article
originally appeared at Emergency Physicians Monthly.
The authors of
this column receive no funding or incentives from any pharmaceutical
company, and have no conflicts of interest related to the topics of
their articles. Furthermore, Praxbind is not an advertising client of
Emergency Physicians Monthly.
This article is a collaboration between MedPage Today® and:
HOUSTON -- Direct aspiration of
large-vessel ischemic strokes was as safe and successful for reperfusion
as stent retriever use, the ASTER trial showed.
The rate of TICI 2b/3 reperfusion was 85.4% with the direct
aspiration first pass technique (ADAPT) and 83.1% with stent retriever
as the first-line strategy (P=0.53), Bertrand Lapergue, MD, PhD, of Foch Hospital in Suresnes, France, and colleagues reported here at the International Stroke Conference.
All
safety endpoints, including new territory embolization or infarct,
arterial perforation, arterial dissection, vasospasm, and intracranial
or subarachnoid hemorrhage, likewise were similar between treatment
strategies.
While stent retriever use has been a real advance for these large
vessel occlusions, "it's good, but we think we need to increase the rate
of successful reperfusion and perfect reperfusion," Lapergue said at a
press conference for the late-breaking clinical trial session.
The direct aspiration technique is reasonable as an alternative first-line strategy, concluded Ralph L. Sacco, MD,
of the University of Miami, past president of the American Heart
Association and president-elect of the American Academy of Neurology,
who served as a discussant at the briefing.
He cautioned, though, that the trial's French population may raise
issues for generalizability. Stent retriever use could plausibly be
better for the intracranial atherostenosis that is a more common source
of ischemic stroke in certain U.S. populations than the embolic
occlusions more common in French populations, he said.
Lapergue countered that there are some data suggesting that whereas
stent retriever use can destabilize plaque in the vessel, aspiration is a
"very traumatic technique."
A
similar U.S. trial, COMPASS, is more than two-thirds enrolled and
should report results within the year to answer that issue, noted
another member of the panel, Ricardo A. Hanel, MD, PhD, of the Baptist Neurological Institute in Jacksonville, Fla.
Meanwhile, though, this trial was important as the first to support
the idea that as long as the vessel gets recanalized, it might not
matter how you get there, Hanel said.
And if all else is equal in terms of efficacy and safety, cost may be
a deciding factor in clinical use, both he and Lapergue agreed, noting
that the aspiration technique is less expensive, although with more
rescue therapy use.
"If the catheter is used as primary line, it might be that we have the second factor as saving a $6,000 device," Hanel said.
The ASTER trial was a prospective, multicenter, controlled open-label
comparison of the two strategies with blinded outcome evaluation.
Patients who met large-vessel, posterior circulation ischemic stroke
criteria on imaging were randomized to either direct aspiration (n=192)
or stent retriever use (n=189) first-line, with a switch to other
therapy allowed after three failed attempts
This is good after being diagnosed but you better hope your ER department has good enough tools to identify these cases in the first place. Because you don't want this to happen!
Sounds like something useful to identify locked-in-syndrome. Are you positive your emergency department has this available and knows how to use it? What is your ER protocol to identify such patients? http://www.alphagalileo.org/ViewItem.aspx?ItemId=166432&CultureCode=en
New research suggests that
an electroencephalogram (EEG) could be a strong indicator of the level
of awareness of patients in a vegetative state after a severe brain
injury.
Functional magnetic resonance imaging (fMRI) has repeatedly shown
that a significant minority of patients diagnosed as in the vegetative
state are actually aware, but unable to show it reliably with their
behaviour.
The new research findings, published in Annals of Neurology, suggest a
correspondence between a patient’s ability to generate an EEG marker of
attention to tactile stimulation, and their ability to produce the
critical clinical marker of awareness by following verbal commands.
Crucially, this relationship existed for patients who could only follow commands with the more expensive methods of fMRI.
The mental demands of the EEG task are lower than the demands of the
fMRI tasks. Furthermore, EEG is entirely portable, inexpensive, and
available in the majority of hospitals.
The researchers state that this more simple EEG assessment may be
capable of diagnosing a patient’s level of awareness without the need
for expensive and challenging fMRI scans, thereby increasing the number
of patients who may benefit from a more accurate diagnosis.
14 patients were selected for the study, across levels of awareness
and behavioural ability; seven in a vegetative state, four in a
minimally conscious state, two emerging from a minimally conscious
state, and one with locked in syndrome.
Each patient’s surrogate decision maker provided informed, written
consent for the patient’s participation in the study. As a scientific
control, a sample of fifteen healthy volunteers also participated in the
tasks.
The patients completed two sets of brain imaging tasks:
· Vibrating stimulators affixed to each wrist and the upper
back administered non-painful pulses five times per second while the
patients’ EEGs were recorded. 80% of these vibrations occurred on the
upper back. The relatively more infrequent vibrations on the wrists (20%
of the time) produce changes in a healthy individual’s EEG that reflect
attention being drawn toward the new location of stimulation.
· During separate fMRI scans, patients were asked to engage
in three established measures of a covert ability to follow commands –
imagining playing tennis, imagining walking around the house, and
counting target words in a stream of distractors.
All patients whose EEGs showed evidence of attention being directed
toward the infrequent tactile stimuli were also able to display evidence
of following commands in the fMRI tasks.
Similarly, most patients (five of six) who did not generate a
response to the EEG task did not generate evidence of command following.
Dr Damian Cruse, from the University of Birmingham, explained, “A
bedside EEG may work as a cost-efficient and portable way of improving
the accuracy of diagnosis in disorders of consciousness. While current
clinical diagnoses are accurate for many patients, recent reports
estimate that as many as 15% of patients considered to be in a
vegetative state could retain awareness that cannot be detected reliably
from their behaviour alone.”
“The ultimate aim is to provide more accurate diagnoses for all
patients, thus directing appropriate rehabilitation and therapy to those
most likely to benefit.”
Full bibliographic information'Somatosensory
attention identifies both overt and covert awareness in disorders of
consciousness'; Raechelle M. Gibson, Srivas Chennu PhD, Davinia
Fernández-Espejo PhD, Lorina Naci PhD, Adrian M. Owen PhD, Damian Cruse
PhD; Annals of Neurology; DOI: 10.1002/ana.24726
What to do in an emergency is pretty useless if our ER doctors still can't objectively diagnose a stroke. You can do the lazy awareness crap after you have solved the more important problem of fast easy and accurate diagnosis of stroke and its type. But our fucking failures of stroke associations think this is more important than solving actual problems in stroke. http://www.alphagalileo.org/ViewItem.aspx?ItemId=165166&CultureCode=en
Mobile devices, social media, visual media and crowdsourcing have the
potential to improve emergency care for cardiac arrests, heart attacks
and strokes, according to a new scientific statement from the American
Heart Association.
The new statement, published in the American Heart Association
journal Circulation, reviewed scientific studies to evaluate current
knowledge on the effectiveness digital strategies at improving emergency
cardiac and stroke care.
“When seconds count, early recognition of the symptoms of cardiac
arrest, heart attack or stroke and quick action can make a huge
difference in whether someone lives or dies or has serious complications
afterwards,” said Raina Merchant, M.D., M.S.H.P., director of the
Social Media Lab at the Penn Medicine Center for Health Care Innovation
in Philadelphia, Pennsylvania, and co-author of the new scientific
statement. “Digital platforms can support existing efforts to educate
people about what to do in an emergency. Learning what to do – including
how to perform CPR and recognizing the symptoms of stroke – is
something many people can do that can save lives.”
Some studies on digital strategies have shown positive results, such
as a Swedish study that used a mobile phone application to alert
volunteers within 500 meters of a cardiac arrest victim to respond and
start CPR. It found that 62 percent of the volunteers with the app
started CPR, while only 48 percent of bystanders without the app started
CPR.
A Japanese study found that when emergency department personnel sent
pictures of 12-lead ECGs via their smartphone to interventional
cardiologists for interpretation, the smartphone method shaved 1.5
minutes off the time clinicians needed to diagnose a patient, compared
to sending the images via fax.
Smartphone apps to view brain images for stroke and Face Time
videoconferencing apps to assess stroke patients by a remote neurologist
may also be feasible.
However, the statement authors emphasize that, while the potential
for applying these tools to improve care is compelling, they require
evidence of their effectiveness.
While no research to date has shown negative results of using digital
tools for emergency cardiac or stroke care, the authors raise the issue
of unintended consequences to patients due to inaccurate information
being provided via digital tools, which could lead to medical errors and
higher costs, and the risk of disclosing patients’ health information
in violation of federal privacy law.
“As many of these interventions are new and emerging, it is an
optimal time to conduct rigorous evaluations just as are done for
traditional medical therapies and interventions,” Merchant said.
Some unanswered questions that should be the focus of future studies include:
Can mobile devices be converted into defibrillators?
Can video sharing platforms help real-time bystander CPR and automated external defibrillator (AED) coaching?
Can emergency personnel use cell phones to pinpoint the best
hospital for treatment based on the patient, traffic, hospital readiness
and average treatment times?
Full bibliographic informationUse
of Mobile Devices, Social Media, and Crowdsourcing as Digital
Strategies to Improve Emergency Cardiovascular Care: A Scientific
Statement From the American Heart Association Statement co-authors
are John Rumsfeld, M.D., Ph.D.; Steven Brooks, M.D., M.H.Sc.; Tom
Aufderheide, M.D.; Marion Leary, M.P.H, M.S.N., R.N.; Steven Bradley,
M.D., M.P.H.; Chileshe Nkonde-Price, M.D., M.S., M.R.C.P.; Lee Schwamm,
M.D.; Marielle Jessup, M.D. and Jose Maria Ferrer, M.D. Author
disclosures are on the manuscript.
To educate the public about stroke risk and prevention, the National Stroke Association declares May National Stroke Awareness Month.
At the heart of the campaign is a video called StreetSmart, in which representatives from the National Stroke Association asked passersby on Denver streets what they knew about stroke.
“We were surprised by people’s responses, which ranged from no
knowledge about stroke to some knowledge of the seriousness of stroke,”
says Robyn Moore, chief executive officer of National Stroke
Association, in a media release.
“The public is alarmingly uninformed about stroke, which can happen
to anyone at any time. It’s vital that the public be aware of stroke’s
symptoms and act fast to get someone experiencing a stroke to an
emergency room,” she adds.
During the campaign, the public is encouraged to help spread
awareness through various channels, ranging from social media and
downloading resource materials to becoming involved in legislative
advocacy at the state and federal levels.
“Our campaign gives people the tools to become informed and spread
our message about stroke,” Moore states in the release. “Even something
as simple as posting on Facebook or sending one of our colorful eCards
about stroke risks to family members and friends will make a difference
in getting everyone to wise up about the symptoms of stroke and
prevention.”
For more information, visit National Stroke Association.
[Source(s): National Stroke Association, PR Newswire]
Which is the bigger problem? ER doctors that can't diagnose a stroke? Or people that can't recognize a stroke? I would argue lets fix the ER problem first but the NSA in its wisdom focuses on the press release problem of awareness.
According
to research, less than one third of people can recognize more than one
stroke symptom. So National Stroke Association took our cameras to the
streets of Denver to find out just how much the public does know about
stroke. The video, StreetSmart, is part of a National Stroke Awareness
Month campaign in May.
Why not be able to use this for stroke also? At least we wouldn't have emergency room doctors accusing young stroke patients of being drunk or drugged and spending hours with millions of neurons dying until they are treated.
SyncThink,
a company that has led the field of eye tracking technology, has
announced that it has received FDA clearance for its medical device,
EYE-SYNC, which uses infrared cameras to determine within 60 seconds if
someone has endured a concussion.
Concern about concussions is clearly a very public issue now for
athletes. By measuring visual target motion, this handheld, virtual
reality, eye-tracking technology can determine whether an athlete
has been concussed. It’s often faster than a medical examiner, the
company said.
SyncThink, which has headquarters and research staff in Boston, New
York and Palo Alto, collaborated with the Brain Trauma Foundation in
developing this device.
“In my opinion, the EYE-SYNC device has significant implications for
sideline evaluation, and I can see in the future how this can be the
diagnostic gold standard for sports related concussion with every pro,
college and high school team having one on the field,” Scott Anderson,
director of athletic training for Stanford University Sports Medicine,
said in a SyncThink statement.
Anderson said that Stanford Sports Medicine is testing EYE-SYNC as an
investigational device to screen athletes for concussions and help
decide if it is safe for them to return to play.
SyncThink claims more than 40 peer-reviewed research articles
demonstrating the effectiveness of the device, plus 10 patents and a
database of more than 10,000 people who have been tested with EYE-SYNC.
Author(s)/Faculty: Edward C. Jauch, MD, MS, FAHA, FACEP; Andy S. Jagoda, MD, FACEP; Philip B. Gorelick, MD, MPH, FACP; Lee H. Schwamm, MD, FAHA
Source: Healio - Cardiology Education Lab
Type: Multimedia
Articles/Items: 6
Release Date: 12/11/2015
Expiration Date: 12/11/2016
Credit Type: CME
Number of Credits: 1.5
Cost: Free
Provider:
According
to the American Heart Association, strokes are experienced by
approximately 795,000 Americans each year and remain the leading cause
of disability in North America. It is important for emergency room
physicians to identify and treat patients with acute ischemic stroke
(AIS) quickly in order to best retain patients’ quality of life.
Treatment of AIS is time sensitive, and with the recent updates to the
use of endovascular procedures and thrombolytic therapy, physicians need
to be prepared for a shift in the treatment paradigm without
compromising patient safety. In this activity, leading neurologists and
emergency medicine physicians discuss the latest evidence and
recommendations on stroke management, including updates to guidelines on
thrombolytic use, new data concerning endovascular procedures, and
information on how the use of telemedicine and collaboration between
stroke systems of care can improve processes and patient outcomes.
