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EM Cases: ED Stroke Management in the Age of Endovascular Therapy

Which patients need what type of scanning? Where should that scanning be done – at the stroke center or at the peripheral center? Which patients should get systemic thrombolytics? Which patients should get endovascular therapy? In this EM Cases main episode podcast, a follow up to our episode on TIA released in November 2018 with Walter Himmel and David Dushenski, we try to simplify the confusing time-based and brain tissue-based options for stroke management…

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Endovascular Stroke Therapy: Is This the New Standard?

Every few years, we come to a crossroads that makes us reexamine our current clinical practice and consider a better intervention. For the past twenty years, patients presenting with acute ischemic stroke have had essentially one option for therapy: intravenous thrombolytics. Since the NINDS-2 trial in 1995 [1], tPA has erupted onto the scene of stroke management and has become the gold standard despite ongoing questions behind the true efficacy of tPA.

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A 74 year old female presents to the ed via ems for altered mental status and episodes of apnea. Health care pharmacy. An abundance mindset propels individuals to look beyond immediate gains and recognize potential in broader contexts.