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 678: ECMO for Refractory VFib

Podcast 678: ECMO for Refractory VFib

Contributor: Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac...

8 Kesä 20213min

Podcast 677: Oatmeal Cream for Hand Eczema

Podcast 677: Oatmeal Cream for Hand Eczema

Contributor: Jared Scott, MD Educational Pearls: Hand eczema is present in about 10% of the population and has a great prevalence in hairdressers, healthcare workers, and food service employees Usin...

7 Kesä 20214min

Podcast 676: Spontaneous Bacterial Peritonitis

Podcast 676: Spontaneous Bacterial Peritonitis

Contributor:  Sam Killian, MD Educational Pearls: Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not fro...

31 Touko 20214min

Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines

Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines

This week's Pharmacy Phriday features a short excerpt from a longer podcast released as promo for the Colorado's CURE initiative, Clinicians United to Resolve the Epidemic, that combats the opioid cri...

28 Touko 202121min

Podcast 675: CHF like it's 1966

Podcast 675: CHF like it's 1966

Contributor: Chris Holmes, MD Educational Pearls: Medicine is cyclical and practice is always evolving A description of recommended treatment for CHF from 1966 Give oxygen Give one dose morphine t...

26 Touko 20216min

Podcast 674: Facial Nerve Palsy in Kids

Podcast 674: Facial Nerve Palsy in Kids

Contributor: Aaron Lessen, MD Educational Pearls: Facial nerve palsy (Bell's palsy) can occur in pediatric patients with Lyme disease, viral infection, or even leukemia One trial sought out to find ...

25 Touko 20214min

Podcast 673: Leaving the ED with Naloxone

Podcast 673: Leaving the ED with Naloxone

Contributor: Don Stader, MD Educational Pearls: Patients are more likely to survive an opioid overdose if they have naloxone 10% risk of death in the year following an opioid overdose of patients see...

24 Touko 20216min

Podcast 672: Oxygen Things

Podcast 672: Oxygen Things

Contributor: Aaron Lessen , MD Educational Pearls: Patients on 10L or more of oxygen per minute in the ICU were randomized to oxygen goals of 90% or 96% to compare 90-day mortality rates Mortality ra...

18 Touko 20212min

Suosittua kategoriassa Tiede

tiedekulma-podcast
rss-mita-tulisi-tietaa
rss-poliisin-mieli
rss-duodecim-lehti
docemilia
filocast-filosofian-perusteet
rss-ammamafia
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-sosiopodi
utelias-mieli
radio-antro
rss-astetta-parempi-elama-podcast
rss-tiedetta-vai-tarinaa