Is 15 WBC in CSF Normal? Age-Specific Norms
Normal CSF looks different in neonates and infants 29-60 days. Here are the reference values.
Does Diphenhydramine Help EPS with Prochlorperazine?
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.
New 2018 AHA Stroke Guidelines
The AHA released new 2018 guidelines, which are summarized for Emergency Physicians here. The new guidelines are great, but at 345 pages in length you may want to read the short version.
DEFUSE 3 – A New DAWN in Extending the Stroke Window?
Patients beyond the 6-hour invasive stroke treatment window benefitted from endovascular treatment of proximal MCA or ICA occlusion up to 16 hours from onset if there was a large ischemic penumbra on perfusion imaging that had not yet infarcted.
Delayed Endovascular Stroke Treatment – Beyond the 6-hour Window
Patients with acute stroke from occluded intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA) presenting from 6-24 hours from onset benefitted from endovascular thrombectomy when clinical deficits of stroke were greater than expected based on infarct volume on diffusion-weighted MRI or perfusion CT.
Stroke Oxygen Study
Administering prophylactic low-dose oxygen (2-3L/min) to non-hypoxemic patients with acute stroke did not reduce death or disability at 3 months.
IV Prochlorperazine + Diphenhydramine vs Hydromorphone for Migraines
The primary outcome (quick and sustained headache relief) was achieved in 60% of the IV prochlorperazine + diphenhydramine group vs 31% in the IV hydromorphone group with a NNT of 4. As a result, the study was stopped early.
DOAC vs Warfarin Related Non-Traumatic ICH
Compared with vitamin K antagonist (VKA)-related non-traumatic intracerebral hemorrhage (ICH), direct oral anticoagulant (DOAC)-related ICH had less disability, smaller bleeds, and the meta-analysis showed lower in-hospital mortality rates.
Should We Give Delayed Lytics for Stroke Over Age 80?
Elderly stroke patients over age 80 who received tPA >3 - 4.5 hours from time of onset were more likely to have symptomatic intracranial hemorrhage (SICH), 10% vs 8% in the <3-hour group, but overall mortality and percentage with good neurological outcome was the same in the delayed group as patients who received it in under 3 hours.
Is Analgesic Rebound Headache a Myth?
Medication overuse headache (MOH), also known as rebound headache or drug-induced headache, may be the stuff of legend. The evidence for it is sketchy. The authors say, "Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication."