EM Quick Hits 49 Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Skin Foreign Body Hack, CT Radiation Risk, Emergency Fund

Emergency Medicine Cases - Een podcast door Dr. Anton Helman - Dinsdagen

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Topics in this EM Quick Hits podcast Anand Swaminathan on endovascular therapy for large vessel occlusion ischemic stroke (0:38) Sarah Reid on intussusception clinical pearls and pitfalls (8:45) Andrew Petrosoniak on 5 tips on management of stable penetrating trauma patient (15:49) Peter Toth on slit lamp hack for skin foreign body removal (23:31) Nour Khatib & Jonathan Wallace on CT radiation risk (27:43) Matt Poyner on the importance of an emergency fund (34:21) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Alex Chan, edited by Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Reid, S. Petrosoniak, A. Toth,, P. Khatib, N. Wallace, J. Poyner, M. EM Quick Hits 49 - Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Foreign Body Hack, Radiation Risk, Emergency Fund. June, 2023. https://emergencymedicinecases.com/em-quick-hits-june-2023/. Accessed September 17, 2024. The eligibility criteria of endovascular therapy for large vessel strokes may be expanding in the future * Current guidelines indicate endovascular therapy (EVT) for large vessel occlusion strokes occurring within 24 hours of presentation with neuroimaging demonstrating a small ischemic core with a viable penumbra * The ANGEL-ASPECT and SELECT2 RCTs published in 2023 suggested that patients presenting with large infarcted cores receiving EVT were found to have superior neurologic outcomes compared to medical management alone * In the SELECT Late retrospective study, there additionally appeared to be a benefit of neurologic outcomes for patients receiving EVT despite presenting with large vessel strokes beyond 24 hours of "last known well" * Although the mentioned studies suggest benefit for EVT beyond our current eligibility criteria, further studies are needed before applying the evidence to clinical practices  as SELECT was a retrospective study and biases and limitations were present Update 2024: A prospective, multicenter, open-label, randomized trial including 253 patients with acute ischemic stroke due to large vessel occlusion in anterior circulation and a large established infarct (ASPECTS score of 3-5) and NIHSS less than 26 found that endovascular thrombectomy + medical therapy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2.58, 95%CI 1.6-4.15, P=0.0001), lower mortality (hazard ratio 0.67, 95% CI 0.46-0.98, P=0.038), and increase in patients with independent neurologic outcomes mRS=<2 at 90 days (17% vs 2%, OR 7.16, 95% CI 2.12-24.21, P=0.0016) compared to medical treatment alone. Note - this trial was stopped early for efficacy after the first pre-planned interim analysis. (TENSION trial). Abstract Ep 120 ED Stroke Management in the Age of Endovascular Therapy Expand to view reference list * Huo X, Ma G, Tong X, et al. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med.