Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

The table below summarizes the recommendations for adult patients on anti-thrombotic agents with intracranial hemorrhage (both spontaneous and traumatic). This will be focused on ED management.

Forget the Blood Patch? A Medical Option That Works

Forget the Blood Patch? A Medical Option That Works

Administration of neostigmine and atropine vs placebo, in addition to usual care for post-dural puncture headache (PDPH), was highly effective in this RCT involving healthy postpartum women.

New Risk After TBI - Suicide

New Risk After TBI - Suicide

The incidence of suicide nearly doubled in patients who had traumatic brain injury (TBI) compared to baseline.  Risk increased with severity of injury, number of visits, and was highest in the first 6 months post-injury.

Scan 'Em All - Anticoagulated Minor Head Trauma

Scan 'Em All - Anticoagulated Minor Head Trauma

Incidence of intracerebral hemorrhage (ICH) on CT following minor head trauma in anticoagulated patients was 9%, which means we have to CT all these people.

LR vs NS for Pediatric DKA

LR vs NS for Pediatric DKA

Use of any LR in pediatric patients with DKA, as opposed to only NS, was associated with lower overall costs, similar length of stay, and markedly reduced incidence of cerebral edema in this retrospective study.

Door to tPA Under 20 Minutes - Impressive or Dangerous?

Door to tPA Under 20 Minutes - Impressive or Dangerous?

A door-to-tPA in under 20 minute protocol at this center with 1015 stroke alerts resulted in a misdiagnosis rate of 14.8% and 8 people being harmed.  The authors concluded this was safe.  I'm not so sure about that.

IOTA - Oxygen, Less Is More

IOTA - Oxygen, Less Is More

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

MRI-Guided Alteplase for Wake-Up Stroke

MRI-Guided Alteplase for Wake-Up Stroke

For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy.  Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.

Atraumatic Needles Drastically Reduce Post-LP Headache

Atraumatic Needles Drastically Reduce Post-LP Headache

In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

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