Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Contributor: Aaron Lessen MD

Educational Pearls:

  • A recent study assessed EMS treatment of high blood pressure in the field

  • 2404 patients randomized to prehospital treatment (1205) vs. usual care (1199)

    • Included patients with prehospital BP greater than 150 mm Hg

    • The treatment arm's BP goal was 130-140 mm Hg

    • The primary efficacy outcome was functional status 90 days out

  • Stroke was confirmed by imaging upon hospital arrival

    • On arrival, the mean SBP of the treatment arm was 159 mm Hg compared with 170 mm Hg in the usual care group

  • No significant difference in functional outcomes between the treatment group and the usual care group (Common Odds Ratio of 1.00, 95% CI = 0.87-1.15)

  • Post-imaging analysis revealed 46.5% of the undifferentiated patients had a hemorrhagic stroke

    • Prehospital reduction in BP did reduce the odds of poor functional outcome in hemorrhagic stroke patients alone (Common Odds Ratio 0.75, 95% CI 0.60-0.92)

    • Those with ischemic stroke had increased odds of poor functional outcome (Common Odds Ratio 1.30, 95% CI 1.06-1.60)

  • Bottom line: it is challenging to identify the stroke type in the prehospital setting and therefore not necessarily helpful to treat the blood pressure

References

1. Ren X, Zhang C, Xu P, et al. Intensive Ambulance-Delivered Blood- Pressure Reduction in Hyperacute Stroke. New England Journal of Medicine. 2024;390(20):1862-1872. doi:10.1056/NEJMoa2314741

Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit

Jaksot(1144)

Episode 920: Pediatric Growth Estimates

Episode 920: Pediatric Growth Estimates

Contributor: Sean Fox, MD Educational Pearls: Newborns may lose up to 10% of their birth weight in the first week of life Weight loss is greatest in exclusively breastfed infants Should regain ...

9 Syys 20246min

Episode 919: EKG Criteria for Adenosine

Episode 919: EKG Criteria for Adenosine

Contributor: Travis Barlock, MD Educational Pearls: SVT: supraventricular tachycardia Pharmacotherapy for SVT includes drugs that block the AV node, such as adenosine EKG criteria before adeno...

4 Syys 20241min

Episode 918: Automated Blood Pressure Cuffs

Episode 918: Automated Blood Pressure Cuffs

Contributor: Aaron Lessen, MD Educational Pearls: How does an automated blood pressure cuff work? Automated blood pressure cuffs work differently than taking a manual blood pressure. While taking ...

26 Elo 20242min

Episode 917: Heat-Related Illnesses

Episode 917: Heat-Related Illnesses

Contributor: Megan Hurley, MD Educational Pearls: Heat cramps Occur due to electrolyte disturbances Most common electrolyte abnormalities are hyponatremia and hypokalemia Heat edema Caus...

19 Elo 20244min

Episode 916: Central Cord Syndrome

Episode 916: Central Cord Syndrome

Contributor: Taylor Lynch, MD Educational Pearls: What is Central Cord Syndrome (CCS)? Incomplete spinal cord injury caused by trauma that compresses the center of the cord More common in hyperext...

12 Elo 20246min

Episode 915: Severe Burn Injuries

Episode 915: Severe Burn Injuries

Contributor: Megan Hurley, MD Educational Pearls: Initial assessment of patients with severe burn injuries begins with ABCs Airway: consider inhalation injury Breathing: circumferential burns ...

5 Elo 20244min

Podcast 914: Neuroleptic Malignant Syndrome (NMS)

Podcast 914: Neuroleptic Malignant Syndrome (NMS)

Contributor: Taylor Lynch, MD Educational Pearls: What is NMS? Neuroleptic Malignant Syndrome Caused by anti-dopamine medication or rapid withdrawal of pro-dopamenergic medications Mechanism is ...

29 Heinä 202410min

Episode 913: Vasopressors after ROSC

Episode 913: Vasopressors after ROSC

Contributor: Travis Barlock MD Educational Pearls: Recent study assessed outcomes after ROSC with epinephrine vs. norepinephrine Observational multicenter study from 2011-2018 285 patients rece...

23 Heinä 20241min

Suosittua kategoriassa Tiede

rss-mita-tulisi-tietaa
rss-poliisin-mieli
rss-duodecim-lehti
tiedekulma-podcast
rss-lihavuudesta-podcast
docemilia
utelias-mieli
mielipaivakirja
radio-antro
sotataidon-ytimessa
filocast-filosofian-perusteet
rss-laakaripodi
rss-mental-race
rss-opeklubi
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-sosiopodi