Episode 909: Prehospital Blood Pressure Management in Suspected Stroke
Emergency Medical Minute24 Juni 2024

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

Avsnitt(1145)

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 Juli 20241min

Podcast 912: Narcan (Naloxone)

Podcast 912: Narcan (Naloxone)

Contributor: Taylor Lynch, MD Educational Pearls: Opioid Epidemic- quick facts Drug overdoses, primarily driven by opioids, have become the leading cause of accidental death in the U.S. for individu...

15 Juli 20246min

Episode 911: Anticholinergic Toxicity

Episode 911: Anticholinergic Toxicity

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressa...

8 Juli 20247min

Episode 910: Cellulitis Recovery Timeline

Episode 910: Cellulitis Recovery Timeline

Contributor: Aaron Lessen, MD Educational Pearls: How fast does cellulitis recover? A recent prospective cohort study took a look at this question. The study included 300 adults with cellulitis ...

2 Juli 20241min

Episode 908: Sympathomimetic Drugs

Episode 908: Sympathomimetic Drugs

Contributor: Taylor Lynch MD Educational Pearls: Overview: Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine Limited th...

17 Juni 20247min

Episode 907: Wide-Complex Tachycardia

Episode 907: Wide-Complex Tachycardia

Contributor: Travis Barlock MD Educational Pearls: Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds Wide-complex tachycardia of supraventricular or...

12 Juni 20243min

Episode 906: Case Study of Hypernatremia

Episode 906: Case Study of Hypernatremia

Contributor: Aaron Lessen MD Educational Pearls: The case: A gentleman came in from a nursing home with symptoms concerning for sepsis. He was hypotensive, hypoxic, febrile, and mentally altered. ...

3 Juni 20243min

Populärt inom Vetenskap

p3-dystopia
dumma-manniskor
svd-nyhetsartiklar
allt-du-velat-veta
pojkmottagningen
kapitalet-en-podd-om-ekonomi
det-morka-psyket
dumforklarat
rss-vetenskapsradion-2
halsorevolutionen
rss-vetenskapsradion
rss-ufo-bortom-rimligt-tvivel
rss-spraket
rss-experimentet
sexet
medicinvetarna
vetenskapsradion
paranormalt-med-caroline-giertz
4health-med-anna-sparre
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli