What is Emergency Medicine -Do people who suffer TIAs likely need to be admitted to the hospital?10/31/2022 What is Emergency Medicine -Do people who suffer TIAs likely need to be admitted to the hospital? Though many hospitals take in TIA patients, a rising proportion employ emergency department observation units or outpatient TIA clinics to carry out the urgent diagnostic tests and start treatment.
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What is Emergency Medicine -What makes a TIA a cause for concern?
High early acute stroke risk is linked to TIAs (up to 10% within the first two days). What is Emergency Medicine -A transient ischemic attack (TIA) is what?
Although most TIAs resolve in an hour, the traditional definition of a TIA has been predicated on time (i.e., 24 hours of symptoms). On diffusion-weighted magnetic resonance imaging, acute ischemia lesions can be seen in up to 67% of classic TIAs (MRI). The American Heart Association and American Stroke Association (AHA/ASA) switched to a tissue-based description of TIA in 2009 because there is no time cut-off point that can reliably determine whether an underlying ischemic infarction has occurred. This is because transient symptoms without tissue injury were confirmed by neuroimaging. What is Emergency Medicine -What factors lead to ischemic stroke?
Small vessel disease, atherosclerosis, thrombosis, and vasculitis Low cardiac ejection fraction, mechanical heart valve, embolic, atrial fibrillation, and • Cervical artery dissection; endocarditis; atrial septal defects; (i.e., carotid or vertebral arteries) What is Emergency Medicine -What about those using novel or direct oral anticoagulants (NOACs/DOACs)?
Direct thrombin inhibitors and direct factor Xa inhibitors, often known as NOACs or DOACs, have been made available by pharmaceutical companies. These medications are gaining popularity since they are simpler to administer and have a reduced risk of bleeding than more established medications like warfarin. The partial thromboplastin time/prothrombin time (PTT/PT) and INR, two common coagulation investigations, frequently underestimate the extent of anticoagulation in these patients. Options include dialyzing off the medication, reversal using PCCs, and the use of certain reversal drugs (idarucizumab, andexanet). Some facilities may employ alternative medicines like tranexamic acid or thromboelastography-guided therapy (TXA). It is advisable to utilize a team-based approach to management because this is a field of medicine that is still developing. This team may include neurosurgeons, hematologists, pharmacists, and blood banks. What is Emergency Medicine - How should I handle the case of a patient who is taking anticoagulants and has suffered a hemorrhagic stroke?
Oral anticoagulants will be taken by about 13% of hemorrhagic stroke patients. It has typically been advised to entirely reverse the effects of the medicine in individuals on conventional vitamin K antagonists by utilizing both vitamin K and fresh frozen plasma (FFP). Prothrombin complex concentrates (PCCs), plasma-derived factor concentrates, have recently been developed. They have been demonstrated to normalize an aberrant international normalized ratio (INR) more quickly, but no reduction in mortality or morbidity has yet been identified. The factor deficiency should be completely restored in individuals with specific abnormalities, such as hemophilia, and platelets should be administered to those with thrombocytopenia. According to the PATCH trial, platelet transfusion has been proven to worsen outcomes for individuals using antiplatelet medications like aspirin or clopidogrel. What is Emergency Medicine -What is the next step in treating a patient with suspected SAH if the noncontrast head CT is negative and more than six hours have passed since the headache began?
The research on this subject is changing, but most medical professionals continue to advise against performing a lumbar puncture within six hours of the onset of a headache. The noncontrast head CT does not have 100% sensitivity, and it would be disastrous to miss even one patient with SAH. This is the basis for the explanation. However, this strategy has not yet been prospectively verified. The absence of aneurysms on CT angiography could lower the risk of aneurysmal hemorrhage and effectively rule out SAH. Furthermore, up to 5% of people over 50 will develop an accidental aneurysm, leading to a false-positive test result. What is Emergency Medicine - How sensitive is a non-contrast head CT scan for subarachnoid hemorrhage (SAH)?
Numerous studies have demonstrated that no additional testing is required if a negative CT is obtained within six hours of the onset of symptoms because it has a 100% sensitivity to rule out SAH. It is significant to highlight that the literature consistently shows that the sensitivity of head CT decreases with time after headache start. 95% within 24 hours, 80% at 48 hours, 70% at 72 hours, and 50% at 5 days is a plausible prediction. What is Emergency Medicine - What historical traits characterize subarachnoid hemorrhage (SAH)?10/31/2022 What is Emergency Medicine - What historical traits characterize subarachnoid hemorrhage (SAH)?
The "worst headache of my life" or a "thunderclap" headache are the two most commonly reported complaints. SAH affects up to 15% of people who experience the worst headaches of their lives all at once. Patients with SAH, however, may also experience localized neurologic impairments, syncope, depression, or seizures. It is useful to inquire about the interval between the onset of the headache and its peak intensity. The Ottawa SAH Rule has received the most thorough validation. Despite having 100% sensitivity, this rule only had 14% specificity. What is Emergency Medicine -What causes atraumatic subarachnoid hemorrhage (SAH) most frequently?10/31/2022 What is Emergency Medicine -What causes atraumatic subarachnoid hemorrhage (SAH) most frequently?
With an 80 percent prevalence, cerebral aneurysms are the most frequent cause of SAH. These aneurysms grow with time, so aging increases their prevalence. Vertebral artery dissection and arteriovenous malformations are additional causes of SAH. A tiny percentage are brought on by perimesencephalic hemorrhage, a kind of bleeding with an almost invariably benign history that has no recognized source. |
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