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(1145)

Podcast 810: Tooth Replantation

Podcast 810: Tooth Replantation

Contributor: Jarod Scott, MD Educational Pearls: There is a 1-hour window for tooth replantation in ED Cold milk is often best transport media unless there is access to specialized solutions (Hank's ...

5 Syys 20224min

Podcast 809: Achilles Tendon Rupture

Podcast 809: Achilles Tendon Rupture

Contributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset...

30 Elo 20224min

Podcast 808: BVM and PEEP Valve

Podcast 808: BVM and PEEP Valve

Contributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the press...

29 Elo 20224min

Podcast 807: Ring Removal Tricks

Podcast 807: Ring Removal Tricks

Contributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal.  Ring cutters and trauma...

23 Elo 20224min

Podcast 806: Normal ECGs

Podcast 806: Normal ECGs

Contributor: Jared Scott, MD Educational Pearls: Physicians are typically advised not to trust computer interpretation of ECGs Retrospective study was done of computer interpreted normal ECGs to eva...

22 Elo 20223min

Podcast 805: Tunneled Peritoneal Catheter

Podcast 805: Tunneled Peritoneal Catheter

Contributor: Aaron Lessen, MD Educational Pearls: Patients with recurrent ascites may need frequent outpatient or emergency department paracentesis which can be time consuming and uncomfortable for p...

16 Elo 20223min

Podcast 804: Brugada Criteria for V Tach

Podcast 804: Brugada Criteria for V Tach

Contributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The ma...

9 Elo 20226min

Podcast 803:  Sedation During Intubation

Podcast 803: Sedation During Intubation

Contributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications  Patients who suffer from this eff...

8 Elo 20223min

Suosittua kategoriassa Tiede

tiedekulma-podcast
rss-mita-tulisi-tietaa
rss-poliisin-mieli
docemilia
radio-antro
rss-duodecim-lehti
rss-ammamafia
rss-sosiopodi
utelias-mieli
ihanat-ipanat
mielipaivakirja
filocast-filosofian-perusteet
rss-bios-podcast
rss-tiedetta-vai-tarinaa