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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

Rapid IJ (aka Easy Internal Jugular Cannulation)

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lunes, 9 de noviembre de 2015

AVC isquémico: tratamiento

Ischemic Stroke Treatment Archive
R.E.B.E.L.EM - Posted by Salim Rezaie
"I recently returned from the American College of Emergency Physicians (ACEP) Conference which took place from Oct. 26th – 29th, 2015 in Boston, MA. There were really a lot of amazing talks by so many amazing speakers but one lecture in particular by David Newman, of SMART EM and The NNT fame, made me realize that there is just so much research on treatment of ischemic stroke, that I can’t even keep them straight. So what I thought I would do is create an archive of all that research and continue to add to the list as more research is released. I don’t know about you, but I find myself spending lots of time looking this information up every time I need it...
Systemic Lytic Therapy in the Treatment of Ischemic Stroke
What does the American College of Emergency Physicians (ACEP) 2015 Clinical Policy Say? [PDF HERE]
  1. Is IV tPA safe and effective for patients with acute ischemic stroke if given within 3 hours of symptom onset?
    1. Level A recommendations: None specified.
    2. Level B recommendations: With a goal to improve functional outcomes, IV tPA should be offered and may be given to selected patients with acute ischemic stroke within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. The increased risk of symptomatic intracerebral hemorrhage (sICH) should be considered when deciding whether to administer IV tPA to patients with acute ischemic stroke.
    3. Level C recommendations: When feasible, shared decision making between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke (Consensus recommendation).
  2. Is IV tPA safe and effective for patients with acute ischemic stroke treated between 3 to 4.5 hours after symptom onset?
    1. Level A recommendations: None specified.
    2. Level B recommendations: Despite the known risk of symptomatic intracerebral hemorrhage (sICH) and the variability in the degree of benefit in functional outcomes, IV tPA may be offered and may be given to carefully selected patients with acute ischemic stroke within 3 to 4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication.
    3. Level C recommendations: When feasible, shared decision making between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke (Consensus recommendation).
Endovascular Treatment of Ischemic Stroke
What should we take away from the above endovascular studies?
  • Only a very limited population will benefit from endovascular therapy
    • Patients with “Severe Strokes”
    • Proximal Large Vessel Occlusions (Anterior Circulation)
    • Salvageable Brain Tissue (Small Infarcted Core and Collateral Blood Flow)