This week we cover "Thrombolysis with alteplase 3–4.5 hours after acute ischemic stroke: trial reanalysis adjusted for baseline imbalances", a reanalysis of ECASIII and tPA for stroke.

The EM educator series covers Fournier gangrene this week.

Journal Feed covers VL vs. DL, propylthiouracil vs. methimazole, fludrocortisone plus hydrocortisone for septic shock.

This week we cover the EXTEND-IA TNK study, which evaluates TNK versus tPA before thrombectomy.

Today the emDOCs cast covers CAR T-cell therapy and Cytokine Release Syndrome.

A 72-year-old male presents with left-sided flank pain for the last two weeks that has worsened over the past several hours. He also feels lightheaded when standing today. He is tachycardic to 124 beats per minute and hypotensive to 117/84 mm Hg relative to his chart baseline which has an average systolic in the 160s mmHg. You cannot reproduce his pain on your abdominal exam, but you feel a thrill with deep central abdominal palpation. What is the likely diagnosis, and what are your initial steps in evaluation and management?

EM Educator returns with meningitis.

Journal Feed looks at hyperacute T waves, early PCC in trauma, and ST elevation in aVR.