Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,991 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.
How does this compare to this from May 2017? If your doctor doesn't know this they are fucking incompetent and need to be fired. I take no prisoners in making stroke response better.
If you were actually to think about this, lowering blood pressure makes no sense for clot strokes. You would be reducing the oxygen supply to the penumbra, increasing the death rate of those neurons. Does anyone in stroke think or have a strategy at all?
HONOLULU -- Nitroglycerin given by
paramedics to rapidly lower blood pressure for suspected acute stroke
patients didn't improve outcomes and showed a strong signal of being
dangerous in the RIGHT-2 trial.
"I'm delighted to give you another neutral study," quipped Philip
Bath, MD, of the University of Nottingham City Hospital in England, in
reporting the late-breaking trial here at the American Heart
Association's International Stroke Conference, results of which were
simultaneously published in The Lancet.
Functional
outcome as measured by the modified Rankin Scale (mRS) at 90 days
showed no difference in the overall trial population, with an average of
3 points on the 7-point scale in both those who got the patch and those
who got sham dressings and a nonsignificant adjusted common odds ratio
(OR) of 1.04 for poor outcome (P=0.69).
Even among those with a final diagnosis of stroke or transient
ischemic stroke, both groups averaged the same mRS of 3, although the
adjusted common OR for poor outcome strongly trended to higher risk with
nitroglycerin at 1.25 (P=0.083).
"We were close to getting a negative trial," Bath said. "It is
technically neutral, [but] we were well on our way to being negative."
Among secondary outcomes, the intervention was worse in patients with intracerebral hemorrhage (P=0.057), the most severe strokes (National Institutes of Health Stroke Scale score over 12, P=0.044), and those enrolled within an hour of symptom onset (P=0.014).
There's no reason to go further with nitroglycerin in this setting,
but there are lessons for future trials of other agents, commented
Jeffrey Saver, MD, of the University of California, Los Angeles, whose FAST-MAG trial of prehospital magnesium also flopped.
"We
now know for sure that two neuroprotective agents don't work --
magnesium and nitroglycerin. Those are the only two that have been
tested in the realistic time frame," he told MedPage Today. "We
clearly have more work to do. There were concerning, unexpected adverse
effects with the nitroglycerin. Would you do a vasoactive as opposed to
a neuroprotective agent early on? This trial is going to suggest we
should be cautious when doing that."
An accompanying editorial
agreed that it may be the end of the line for blood pressure lowering
in this setting, as transdermal nitroglycerin (or glyceryl trinitrate)
is a nitric oxide donor that lowers blood pressure through vasodilation.
"We believe the clinical community now has data from numerous
populations suggesting that blood pressure lowering in the acute and
hyperacute setting is not beneficial to patients with stroke," wrote
Karen Johnston, MD, of the University of Virginia in Charlottesville,
and Valerie Durkalski-Mauldin, PhD, of the Medical University of South
Carolina in Charleston.
Nitroglycerin did have the expected impact on blood pressure, which
was 5.8/2.6 mm Hg lower after initial treatment and 5.3/2.6 mm Hg lower
than in the sham group on day 2. "However, these differences between
groups in blood pressure might not be considered clinically relevant in
this setting," the editorial noted.
Hopes for very early intervention aren't dead, though, Saver said,
pointing to hypothermia and a novel group of oxygen diffusion enhancers
being investigated for neuroprotection in the prehospital setting.
Other
lessons for future hyperacute stroke treatment trials are "to consider
the implications of enrolling, yet excluding, stroke mimics in the
primary analysis," given the higher than expected rate of such patients
in RIGHT-2, the editorialists said.
Whereas the trial was powered with the assumption of 20% stroke
mimics, additional patients had to be enrolled after the rate was
initially over 30%. In the end, 26% of the 1,149 enrolled had stroke
mimics while 52% had ischemic stroke, 13% intracerebral hemorrhage, and
9% transient ischaemic attack.
FAST-MAG had avoided the stroke mimic problem (only 4% in that trial) through use of telemedicine consultation in the ambulance.
RIGHT-2 enrolled patients with presumed stroke, face-arm-speech-time
(FAST) score of 2 or 3, and systolic blood pressure above 120 mm Hg who
were seen by eight ambulance services in the U.K. They were randomized
to a nitroglycerin patch or a sham patch within 4 hours of symptom
onset. The first dose was given by paramedics in the ambulance and three
others were planned over the subsequent days, although adherence to the
following doses in hospital was low.
Results were similar between groups for treatment-related mortality and serious adverse events.
The study was funded by the British Heart Foundation.
Bath disclosed relationships with Platelet Solutions, Moleac, DiaMedica, Phagenesis, Nestle, and ReNeuron.
Saver disclosed being an advisor for the RIGHT-2 trial.
I bet your doctor and hospital have completely failed in setting this up for use in the ambulance or ER. Vast incompetency for your hospital since 2002 and 2010. I'm thinking drawing and quartering is too light a punishment. A bad stroke would be appropriate, they can appreciate how fucking bad stroke rehab is.
Earlier instructions on nitroglycerin use:
In the book 'Pharmacology for the Ems Provider' issued 2002 - are nitroglycerin instructions for
ischemic and hemorrhagic survivors, link below and search for
nitroglycerin, page 296-7 contains what your ER doctor is probably
interested in. So when in the ER ask your ER doctor what they are doing
to prevent neuronal death.
A Utah State Stroke System Toolkit below also contains instruction on use. 43 pages. page 30 contains nitro instructions, June, 2010 ReceivingStrokeFacility Toolkit
A skin patch costing as little as 39p could revolutionise stroke treatment, significantly increasing the chances of survival, researchers have found.
The patch contains glyceryl trinitrate (GTN), which lowers blood
pressure and opens up blood vessels, helping reduce the damage caused in
the immediate minutes and hours following a stroke.
A stroke is usually caused by an artery clot or burst blood vessel in
the brain and causes permanent disability in about a quarter of
patients.
A small trial of 41 randomised patients in and around Nottingham
found that administering the patch to a patient’s shoulder or back while
they were travelling to hospital halved the stroke death rate from 38%
to 16%.
As a result, the British Heart Foundation (BHF)
has funded the University of Nottingham researchers to work with seven
ambulance services to trial the patch on patients and chart their
recovery over 12 months.
Paramedics can administer the patch in the ambulance before arrival in A&E, saving vital time.
Prof Sir Nilesh Samani, the BHF’s medical director, said: “Current
treatment for stroke is fairly limited and patients are dying or
suffering life-changing disabilities as a result.
“This trial uses a simple patch that can be applied rapidly by paramedics as soon as they reach the patient.
“If successful, this could revolutionise treatment for stroke
patients across the UK and potentially globally and could be a huge step
forward in the advancement of stroke treatment which currently lags
behind heart attack treatment.”
There are more than 100,000 strokes in the UK each year, according to the Stroke Association,
and the BHF says 40,000 people die as a result annually, making it the
country’s fourth biggest killer. One in eight strokes are fatal in the
first 30 days.
Advertisement
The cost to the NHS and social care system is estimated at £2bn a year
in England and research has suggested the cost to society as a whole in
the UK is £9bn.
Funding for stroke research, which was £56m in 2012, is approximately a tenth of the £544m spent on cancer research. Cancer’s cost to the health and social care system is estimated at £5bn a year.
GTN is used for chest pain associated with angina, but the use of the
drug for treating hyperacute stroke is new and the researchers believe
they are the only people in the world testing it.
Prof Philip Bath, a BHF researcher from the University of Nottingham,
said: “We believe that by improving blood flow in the brain in stroke
patients we can dramatically improve their survival chances and
recovery.
“This patch enables us to do this within minutes and early trials have been very promising.”
I wrote about this back in Oct. 2012. When the fuck are our stroke leaders going to put together a stroke protocol on this when it is proven to work? I'm guessing never. Excuse: 'It's not my job'.
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I hadn't heard about this but someone searched for nitroglycerin cream for stroke victims. and got directed to my blog.
In the book
Pharmacology for the Ems Provider - are nitroglycerin instructions for
ischemic and hemorrhagic survivors, link below and search for
nitroglycerin, page 296-7 contains what your ER doctor is probably
interested in. So when in the ER ask your ER doctor what they are doing
to prevent neuronal death.
A Utah State Stroke System Toolkit below also contains instruction on use. 43 pages. ReceivingStrokeFacility Toolkit ------------------------------------------------------------------------------------------------------------------
International nitric oxide trial shows great
results for Kiwis
17 May 2016
An
international trial assessing the effectiveness of nitric
oxide in treating stroke patients shows New Zealanders had
significantly better outcomes than people from other
countries around the world.
Presenting a paper on the
trial at the Royal Australasian College of Physicians (RACP)
Congress in Adelaide on 17 May, Dr Michael Furlong said this
was “a great result for New Zealand”.
Dr Furlong, an
Internal Medicine Physician at Dunedin Hospital was the
Principal Local Investigator in the trial sponsored by the
University of Nottingham.
The trial, funded by grants
from the U.K. Medical Research Council and the BUPA
Foundation investigated the safety of applying
nitroglycerine patches to the skin of acute stroke patients.
It also looked at whether the patches would reduce blood
pressure and brain injury.
Researchers enrolled 4011
patients experiencing acute ischaemic or haemorrhagic
stroke. Patients were enrolled at 173 sites in 23 countries
across five continents between July 2001 and October 2013. A
majority of patients 3182 (79%) were enrolled in 2008 or
later. Seventy-one New Zealand patients took part in the
trial – 64 (90%) were enrolled at Dunedin Hospital.
During the trial, a nitroglycerine patch or placebo patch
treatment was given to each patient for seven days.
The
key local finding was that 16 percent of New Zealand
sub-group were less likely to suffer severe disability
within 90 days of their strokes than patients in the rest of
the world. This was despite New Zealand patients being over
four years older (74.5 vs. 70.2 years) and having higher
rates of cardiovascular and other related diseases than
others in the study.
The New Zealand subgroup also had
better 90 day outcomes than patients recruited from other
countries in secondary measures such as verbal fluency (11
vs. 9.2) and had shorter initial acute hospital stays (6
days vs. 11 days).
Dr Furlong said during the trial, the
Internal Medicine Department at Dunedin Hospital developed a
Stroke Unit to standardise and improve coordination of
patient care. It included a system where the emergency
department could send urgent tracer calls to members of the
stroke team; this helped the team see patients immediately,
and consider thrombolysis treatment and enrolment in the
trial.
The stroke unit protocols also improved
coordination and standardisation of post stroke care which
may explain some of the superior New Zealand outcomes. This
included excellent nursing care, physiotherapy, occupation
therapy, speech therapy, cardiac monitoring, antiplatelet
therapy, and cholesterol lowering treatment.
“The
superior outcomes for New Zealand patients however, probably
reflect earlier hospital admission and recruitment into the
ENOS trial and therefore greater use of thrombolysis and
exposure to nitroglycerine within six hours.” he said.
Dr Furlong said the benefit of the patches is now the
subject of a second trial (*Right-2) in the U.K. It aims to
recruit 850 patients to provide enough clinical information
to statistically validate the earlier findings.
*Rapid
Intervention with Glyceryl Trinitrate in Hypertensive Stroke
Trial-2 Key facts on stroke in New Zealand
– *Source: The New Zealand Stroke Foundation
• Stroke is the third largest killer in New Zealand.
About 2500 people die as a result of strokes every year.
• Stroke is the major cause of serious adult disability
in New Zealand.
• Stroke is largely preventable, yet
about 9000 New Zealanders have a stroke every year.
•
There are an estimated 60,000 stroke survivors in New
Zealand. Many are disabled and need significant daily
support. However, stroke recovery can continue throughout
life.
Pharmacology for the Ems Provider 2002 - are nitroglycerin instructions for ischemic and hemorrhagic survivors, link below and search for nitroglycerin, page 296-7 contains what your ER doctor is probably interested in. So when in the ER ask your ER doctor what they are doing to prevent neuronal death.
So I wonder if any testing has been done to see if nitroglycerin(glyceryl trinitrate) given to strokees opens the blood vessels that were constricted due to pericytes. Or is this one of those cases where the worry about creating a bleed causes everyone to not do anything. http://stroke.ahajournals.org/content/20/12/1733.short
Its only 23 years old, Who followed up on this? We need a forensic specialist to see what has happened to all the research that showed promise but never made it to clinical practice.
We used a combination of transcranial Doppler ultrasonography and single-photon emission computed tomography to noninvasively assess changes in the diameter of the middle cerebral artery induced by sublingual ( 'under the tongue')nitroglycerin in 10 healthy subjects. Nitroglycerin reduced mean blood flow velocities without concurrently changing regional cerebral blood flow in the perfusion territory of this vessel. Our results strongly suggest that nitroglycerin causes vasodilatation(widening of blood vessels) of the basal intracranial arteries.
