Inclusion: Adult patients presenting to ED with acute ischemic stroke Exclusion: Children < 18 years Level A: None. Level B: Offer IV tPA to acute ischemic stroke patients who meet NINDS inclusion/exclusion criteria and can be treated within 3 hours after symptom onset. Consider increased risk of symptomatic intracranial hemorrhage in decision to administer tPA. (May consider …
Inclusion: Age ≥ 18 Symptomatic elevated BP Lack signs of symptoms of acute target organ injury. Exclusion: Acute hypertensive emergencies (acute stroke, cardiac ischemia, pulmonary edema, encephalopathy, CHF) Pregnant ESRD Emergent conditions that are likely to cause elevated BP not directly related to acute target organ injury Acute presentation of serious medical conditions associated with …
Inclusion: Patients of all age with emergent/urgent condition that require pain +/or anxiety management to accomplish interventional or diagnostic procedure High-risk patients (cardiopulmonary d/o, multiple/head trauma, CNS depressant) w understanding that these patients are at increased risk of complications from procedural sedation and analgesia. Exclusion: Inhalational anesthetics Analgesia for pain control without sedatives Sedation solely …
Inclusion: Adult ≥ 18 with generalized convulsive seizures Exclusion: Pediatrics Complex partial seizures Acute head trauma Multi-system trauma Brain mass or tumor Immunocompromised patients Eclampsia. Level A: Administer additional antiepileptic medication in refractory status epilepticus who have failed treatment with BZDs Level B: Administer IV phenytoin, fosphenytoin, or valproate in refractory status epilepticus who have failed BZD …
Inclusion: Adult ≥ 18 with suspected acute nontraumatic thoracic aortic dissection Exclusion: Traumatic aortic dissection, pediatric, pregnant Level A: None Level B: CTA to exclude thoracic aortic dissection (accuracy similar to that of TEE and MRA). Do not rely on abnormal bedside TTE result to definitively establish diagnosis Level C: Do not use clinical decision rules alone to …
TMP-SMX vs Placebo for Uncomplicated Skin Abscess Talan DA et al.. “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess”. NEJM. 2016. 374(9):823-832. PubMed Full text PDF Clinical Question In settings with MRSA, does Trimethoprim-sulfamethoxazole treatment after Incision and drainage of an abscess result in a greater cure rate? Conclusion Trimethoprim–sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo for abscess that …
