CTE, Chronic Traumatic Encephalopathy, is coming to the forefront of public awareness after numerous professional American football players began suffering a constellation of symptoms: paranoia, confusion, memory lapses, etc. It was initially observed, however, in boxers. It was initially called dementia pugilistica and referred to as being “punch-drunk”. Now we understand that those repetitive blows […]

Note: This article is in response to West End, Pennsylvania Ambulance Services’ ‘One Breath From Death’ Campaign which NeuroEMS.com considers to be unscientific and unethical. Click here to learn more. Here’s what you need to know: 1. The initial decision to take drugs is usually voluntary and people make this choice for various reasons such as […]

A new development in the TPA debate as ACEP (American College of Emergency Physicians) has updated their policy regarding TPA use in stroke. The draft policy can be viewed here in full, but let’s take a look at this: “Patient Management Recommendations Level A recommendations. The increased risk of symptomatic intracerebral hemorrhage (approximately 7% compared to […]

Prehospital use of transcranial ultrasound to diagnose strokes is feasible, according to this paper. The study required stroke neurologists to rendezvous with paramedics on possible stroke calls and perform a physical exam and a transcranial ultrasound. The authors found a sensitivity of 78% and specificity of 98% diagnosing 73 strokes and 29 stroke mimics out of […]

We focus a lot on acute stroke patients. Rapid response. Rapid assessment. Rapid transport. Dispatch, Delivery, Door, and Drug. But what about the other D’s associated with stroke such as Discharge? And Disability? And Depression? Stroke is the chief culprit of serious long term disability in the US. Below is the Modified Rankin Scale (MRS), a […]

Heart Attacks have the benefit of the EKG. A quick test. An expert read. A diagnosis (or close). On top of the EKG blood tests will be ordered. In stroke, there’s no luxury of an easy diagnostic test. The CT won’t necessarily show evidence of an early acute infarct; It’s role is to rule out […]

The 3AM call for a vital signs check is always a frustrating one. We’ve all been there, half-asleep, exhausted, wrinkled uniform. The patient’s blood pressure is high, as usual, and it has been for years. They are non-compliant with medication. Your options now are to transport or secure patient refusal (or perhaps better for those in […]

Published in JAMA last month the Prehospital Acute Neurological Treatment and Optimization of Medical care in Stroke Study (PHANTOM-S; conducted in Berlin, Germany) studied 6182 patients randomized to 1) receiving the standard prehospital care (stroke alert and rapid transport only) versus 2) receiving care via a STEMO (Stroke Emergency Mobile). Let’s skip to the results: […]

Let’s start with a question which we will circle back to later: Have you ever turned red out of embarrassment, stuttered a bit around the person you had a crush on, or felt your hands tremble when you got excited or nervous? Keep that in mind, and let’s move on for now. You respond with […]

In this study out of UCSF, patients were surveyed as to see if they would prefer treatment with fibrinolytic (TPA) therapy in the event of a stroke. Adults over 50 years of age read a scenario where they suffered a stroke and were brought to the emergency department by paramedics. The risks and benefits of TPA therapy […]