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(1146)

Podcast 621: Pediatric Psychosis

Podcast 621: Pediatric Psychosis

Contributor: Aaron Lessen, MD Educational Pearls: Schizophrenia typically doesn't present until age 13 and has a prodrome Prodrome includes months of gradual changes in behavior, starting with negati...

14 Joulu 20203min

Pharmacy Phriday #5: COVID-19 Vaccine for Pregnant Women

Pharmacy Phriday #5: COVID-19 Vaccine for Pregnant Women

Contributors: Rachael Duncan, PharmD and Sean McCullough, PharmD Educational Pearls: A 2019 Report by the National Women's Law Center: Most common occupations for pregnant workers are elementary and ...

11 Joulu 202019min

Podcast 620: Prolactin and Seizures

Podcast 620: Prolactin and Seizures

Contributor: Aaron Lessen, MD Educational Pearls: Serum prolactin levels can be used to help differentiate epileptic seizures from non-epileptic seizures It is also released and elevated after epilep...

8 Joulu 20203min

Podcast 619: Other Uses for Zyprexa

Podcast 619: Other Uses for Zyprexa

Contributor: Don Stader, MD Educational Pearls: Zyprexa (olanzapine) is a second generation antipsychotic with multiple other uses Excellent for treating nausea in patients undergoing chemotherapy or...

7 Joulu 20204min

Podcast 618: Treating Opiate Side Effects

Podcast 618: Treating Opiate Side Effects

Contributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less com...

1 Joulu 20204min

Podcast 617: Masks and Understanding Data

Podcast 617: Masks and Understanding Data

Contributor: Peter Bakes, MD Educational Pearls: Recent study looked at if mask wearing protects the mask wearer from infection This group found 1.8% of mask wearers got COVID while 2.1% of non-mask ...

30 Marras 20204min

Pharmacy Phriday #4: mRNA Vaccines

Pharmacy Phriday #4: mRNA Vaccines

Contributor: Rachael Duncan, PharmD Educational Pearls: ED visits nationwide declined by 42% in April 2020 compared to the same time in 2019 largely due to the fear of the COVID-19 pandemic. The big...

27 Marras 202016min

Mental Health Monthly #5: Borderline Personality Disorder

Mental Health Monthly #5: Borderline Personality Disorder

For this episode of Mental Health Monthly, EMM is honored to collaborate with the hosts of Millennial Mental Health Channel podcast to explain Borderline Personality Disorder and tips to manage patien...

25 Marras 202018min

Suosittua kategoriassa Tiede

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