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 […]

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: […]

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 […]

This study regarding EMS determining last known normal is set to be published this month in ‘Stroke’. In the abstract the authors compared the Last Known Normal time of stroke patients as determined by EMS to the Last Known Normal time as determined by a neurologist. In 91% of cases the EMS-determined time was within 15 minutes […]

Last night we published this editorial and today received an email response from Dr. Bukata. His comments are reproduced in-part below: “[T]he purpose of the chart [Editor’s note: Dr. Bukata is referring to our concern that the imagery associated with his commentary appealed to emotion rather than reason] is to summary the facts — which are straightforward […]

You may have seen the above image circulating recently and/or you may have read this article by Rick Bukata, MD. FAST-MAG was a multicenter randomized, controlled clinical trial out of UCLA studying prehospital administration of magnesium sulfate to treat stroke. The results are in. It didn’t work. Not necessarily surprising. This paper states we’ve tested over 20 drugs in 270 preclinical trials with […]

15-30% of strokes are cardioembolic and 60-90% of stroke patients present with ECG abnormalities. (Source) So let me ask you some questions. Is it important to obtain a 12 lead ECG during a suspected acute stroke in the prehospital setting? Why? Why not? Does it really matter either way? Before we discuss the answer… Here’s the abnormalities you’re likely to […]