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.
For patients with acute intracerebral hemorrhage (ICH), intensive lowering of systolic blood pressure (SBP) with goal SBP < 140 mmHg was associated with increased cerebral ischemia and neurologic deterioration compared to goal SBP < 160 mmHg.
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.
Not surprisingly, patients with mild, non-disabling stroke did not benefit from receiving alteplase over aspirin. If anything, the trend favored aspirin. Five patients (3.2%) who received alteplase had intracranial hemorrhage.
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.
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.
Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.