Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewTransient Ischemic Attacks: Advances in Diagnosis and Management in the Emergency Department.
The definition of a transient ischemic attack (TIA) has evolved over the past decade from a clinical diagnosis to a tissue-based definition based on neuroimaging results. TIA shares the same pathophysiology as stroke, which occurs in up to 5% of patients within 48 hours of the TIA and 10% within 90 days. ⋯ Decision support scores have been developed to risk stratify patients, which include clinical and radiological elements. Antiplatelet and anticoagulant therapy, as well as carotid endarterectomy/stenting have been shown to reduce the stroke occurrence after TIA.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewDiagnosis and Management of Acute Intracerebral Hemorrhage.
Intracerebral hemorrhage (ICH) is the deadliest type of stroke and up to half of patients die in hospital. Blood pressure management, coagulopathy reversal, and intracranial pressure control are the mainstays of acute ICH treatment. Prevention of hematoma expansion and minimally invasive hematoma evacuation are promising therapeutic strategies under investigation. This article provides an updated review on ICH diagnosis and management in the emergency department.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewDiagnosis and Treatment of Central Nervous System Infections in the Emergency Department.
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. ⋯ Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. Therefore, diagnosis of CNS infection requires vigilance and a high index of suspicion based on the history and physical examination, which must be confirmed with appropriate imaging and laboratory evaluation.
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The emergent evaluation and treatment of generalized convulsive status epilepticus presents challenges for emergency physicians. This disease is one of the few in which minutes can mean the difference between life and significant morbidity and mortality. It is imperative to use parallel processing and have multiple treatment options planned in advance, in case the current treatment is not successful. There is also benefit to exploring, or initiating, treatment algorithms to standardize the care for these critically ill patients.
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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. ⋯ 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.