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Use the appropriate order set for all "Code" patients!
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![]() 1. CTA is becoming the standard for acute stroke imaging, but options remain for collateral/penumbral assessment in selecting patients for endovascular reperfusion therapy 2. Non-randomized data support the target mismatch theory for patient selection for endovascular reperfusion therapy 3. NCCT remains the standard for IV tPA treatment decision making, but increased use of routine advanced imaging may ultimately provide data supporting CTP use for IV tPA decision making 4. Ability for advanced imaging to predict who will bleed after reperfusion therapy remains a challenge ![]() • If even considering CVA as diagnosis, call Code Stroke • Consider mechanical thrombectomy in CVA patients who may not be IV tPA patients • Role of head trauma in IV tPA exclusion criteria poorly defined • Always consider VTE in pregnant patients with leg pain • Pregnant & postpartum patients are at significantly increased risk of VTE • Diagnostic workup with Modified Well’s Criteria • Lovenox is the treatment of choice for VTE in pregnancy ![]()
![]() •Consider atypical presentation for ACS in elderly patients •Risk factors for severity of acute pancreatitis include advanced age, obesity, organ failure, and pleural effusion •Can use APACHE II score to risk stratify in the ED •Blunt aortic injury (BAI) is a rare but often deadly entity •Consider in all cases with significant mechanism •Can have atypical/no symptoms or have distracting injury •Management of BAI includes permissive hypotension and rapid transfer to the operating room ![]()
- severe onset of symptoms - worsening clinical course
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-- clamp with hemostat for 2 minutes; -- using crush mark from hemostat; -- perform lateral canthotomy with scissors perpendicularly -- dissect inferiorly and snip the inferior crus of the lateral canthal tendon -- recheck IOP after procedure
![]() I. Characteristics of respiratory artifact
II. The clinical significance of respiratory artifact
III. Respiratory artifact can aid in the recognition of sleep-disordered breathing
b. an abrupt increase in heart rate and the c. simultaneous appearance of very fast RA
b. simultaneously occurring very long respiratory (snoring) artifact followed by c. a sudden increase in the heart rate and resolution of the RA
b. the onset of most periods which contain the RAs show the characteristics of central sleep apnea ![]() Post-Stroke Seizures: 1. CVA is the most common cause of seziures and secondary epilepsy in adults. 2. Blood in the brain is BAD for seizures (ICH and even more so with cerebral infarction with hemorrhagic transformation). 3. In patient's with early-onset (< 30 days) or late-onset (> 30 days) seizures after CVA consider consulting neurology for EEG or initiation of AEDs. Missed ACS/Physician Wellness: 1. Keep a broad differential for hypotension, especially in the diabetic population. 2. Appreciate the affect of stress and poor patient outcomes on you as a provider. 3. Develop strategies for managing stress and proactively addressing your own well-being. |
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