This document summarizes a panel discussion on telemedicine in stroke care. It introduces several panelists who are experts in emergency medicine, neurology, nursing, and pharmacy. It then provides summaries of presentations on various telemedicine programs for stroke, including:
- A Brussels study using telemedicine to assess stroke severity and communicate with neurologists pre-hospital. It showed good reliability.
- The benefits of a telestroke program at Dignity Health Sequoia Hospital, including 24/7 neurological consultations and expedited transfers for treatment.
- The Kaiser Permanente Northern California "Stroke EXPRESS" program, which uses telemedicine to rapidly assess patients and involve neurologists, reducing time to treatment. It
How to reduce time between patient arrival and punctureDr Vipul Gupta
1) The document discusses strategies to reduce time between patient arrival and puncture for endovascular stroke treatment. It emphasizes the importance of a multidisciplinary stroke team and efficient protocols.
2) Times were significantly reduced through parallel processing that allowed for concurrent clinical assessment, imaging, and lab preparation while alerting the neurointervention team.
3) A case example showed door-to-recanalization times under 90 minutes were possible through strict adherence to the parallel processing protocol.
Fetal diagnosis of critical congenital heart defects allows for delivery planning and improved neonatal outcomes according to a study in Western India. Of 100 neonates needing early cardiac intervention, 29 were diagnosed prenatally but only 8 received specialist counseling. Those with prenatal diagnosis presented earlier and in better condition than those diagnosed after birth. Prenatal detection facilitates delivery at a tertiary center equipped for stabilization, reducing transport risks. The study highlights the need for improved fetal screening and counseling to optimize outcomes.
Sophisticated Prehospital Stroke Systems of CarePSOW
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
This document describes efforts at the University of Utah and George E Wahlen VA Medical Center to decrease time to treatment for acute stroke patients. It outlines the previous disorganized stroke response process and near misses. The new standardized "Brain Attack" order set and protocol aims to promptly activate the on-call neurology team, contact the radiology reading room for after-hours imaging, and streamline the workflow to reduce delays. It provides an overview of the updated stroke response steps to recognize symptoms, activate the order set, perform assessments, image interpretation, and determine treatment. The goal is to improve reliability and allow for potential reperfusion therapies.
Presentation 209 ray onders & mary jo elmo diaphramg pacing- what we have ...The ALS Association
This document summarizes research on diaphragm pacing (DP) for patients with respiratory muscle weakness. Key points include: DP was first used in spinal cord injury patients and has since been trialed in over 300 ALS patients. It functions by electrically stimulating the diaphragm to improve breathing. Studies found DP can delay respiratory decline, improve survival rates, treat hypercarbia, and enhance sleep compared to ventilation alone. Optimal candidates have stimulatable diaphragms and meet criteria for non-invasive ventilation. DP is considered a treatment option rather than a last resort measure.
This document discusses emergency teleradiology operations and clinical applications. It describes how teleradiology helps address radiologist shortages globally, especially in remote and rural areas, by allowing for 24/7 emergency radiology coverage. It outlines the key roles and processes involved in emergency teleradiology operations. It also highlights how teleradiology aids in the rapid diagnosis of various acute and life-threatening conditions like trauma, stroke, pulmonary embolism, and acute abdominal issues; helping to expedite treatment decisions and improve outcomes.
The document discusses plans to improve post-acute care for stroke patients in the Show Chwan health system. It proposes creating a comprehensive stroke care bundle that covers patients from the emergency room through post-acute rehabilitation. Key elements include establishing dedicated post-acute care units, assembling multidisciplinary teams to oversee patients' recovery, and strengthening coordination across hospitals in the health system to ensure continuity of care after discharge. The goal is to establish a model program for post-stroke rehabilitation in Taiwan.
How to manage delays in stroke treatment Jacek StaszewskiJacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
How to reduce time between patient arrival and punctureDr Vipul Gupta
1) The document discusses strategies to reduce time between patient arrival and puncture for endovascular stroke treatment. It emphasizes the importance of a multidisciplinary stroke team and efficient protocols.
2) Times were significantly reduced through parallel processing that allowed for concurrent clinical assessment, imaging, and lab preparation while alerting the neurointervention team.
3) A case example showed door-to-recanalization times under 90 minutes were possible through strict adherence to the parallel processing protocol.
Fetal diagnosis of critical congenital heart defects allows for delivery planning and improved neonatal outcomes according to a study in Western India. Of 100 neonates needing early cardiac intervention, 29 were diagnosed prenatally but only 8 received specialist counseling. Those with prenatal diagnosis presented earlier and in better condition than those diagnosed after birth. Prenatal detection facilitates delivery at a tertiary center equipped for stabilization, reducing transport risks. The study highlights the need for improved fetal screening and counseling to optimize outcomes.
Sophisticated Prehospital Stroke Systems of CarePSOW
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
This document describes efforts at the University of Utah and George E Wahlen VA Medical Center to decrease time to treatment for acute stroke patients. It outlines the previous disorganized stroke response process and near misses. The new standardized "Brain Attack" order set and protocol aims to promptly activate the on-call neurology team, contact the radiology reading room for after-hours imaging, and streamline the workflow to reduce delays. It provides an overview of the updated stroke response steps to recognize symptoms, activate the order set, perform assessments, image interpretation, and determine treatment. The goal is to improve reliability and allow for potential reperfusion therapies.
Presentation 209 ray onders & mary jo elmo diaphramg pacing- what we have ...The ALS Association
This document summarizes research on diaphragm pacing (DP) for patients with respiratory muscle weakness. Key points include: DP was first used in spinal cord injury patients and has since been trialed in over 300 ALS patients. It functions by electrically stimulating the diaphragm to improve breathing. Studies found DP can delay respiratory decline, improve survival rates, treat hypercarbia, and enhance sleep compared to ventilation alone. Optimal candidates have stimulatable diaphragms and meet criteria for non-invasive ventilation. DP is considered a treatment option rather than a last resort measure.
This document discusses emergency teleradiology operations and clinical applications. It describes how teleradiology helps address radiologist shortages globally, especially in remote and rural areas, by allowing for 24/7 emergency radiology coverage. It outlines the key roles and processes involved in emergency teleradiology operations. It also highlights how teleradiology aids in the rapid diagnosis of various acute and life-threatening conditions like trauma, stroke, pulmonary embolism, and acute abdominal issues; helping to expedite treatment decisions and improve outcomes.
The document discusses plans to improve post-acute care for stroke patients in the Show Chwan health system. It proposes creating a comprehensive stroke care bundle that covers patients from the emergency room through post-acute rehabilitation. Key elements include establishing dedicated post-acute care units, assembling multidisciplinary teams to oversee patients' recovery, and strengthening coordination across hospitals in the health system to ensure continuity of care after discharge. The goal is to establish a model program for post-stroke rehabilitation in Taiwan.
How to manage delays in stroke treatment Jacek StaszewskiJacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
This study evaluated the diagnostic utility and cost-effectiveness of using a handheld nerve conduction test device to test for carpal tunnel syndrome at a district general hospital. Over 9 months, 141 patients suspected of having carpal tunnel syndrome were tested using the handheld device. The results agreed with traditional nerve conduction studies in 88% of cases. Using the handheld device led to significant cost savings of £16,850 and reduced waiting times. However, 18 patients required further testing, indicating limitations and that traditional testing is still needed if other diagnoses are suspected beyond carpal tunnel syndrome.
This document discusses the management of acute ischemic stroke. It begins by outlining the magnitude of stroke as a problem in India and defines what constitutes a stroke. It then discusses the concepts of penumbra and the importance of short door-to-needle times for thrombolysis. The standard of care for acute ischemic stroke involves rapid evaluation, neuroimaging, ruling out contraindications to thrombolysis, and administration of IV alteplase within 4.5 hours of symptom onset. Barriers to effective stroke treatment in India include delays in recognition of symptoms, reaching care, and administering thrombolysis. Public education on stroke signs and rapid evaluation and treatment are needed to improve outcomes.
This document discusses the management of acute ischemic stroke. It begins by outlining the magnitude of stroke as a problem in India and defines what constitutes a stroke. It then discusses the concepts of penumbra and the importance of short door-to-needle times for thrombolysis. The standard of care for acute ischemic stroke involves rapid evaluation, neuroimaging, ruling out contraindications to thrombolysis, and administration of IV alteplase within 4.5 hours of symptom onset. Barriers to effective stroke treatment in India include delays in recognition of symptoms, reaching care, and administering thrombolysis. Public education on stroke signs and rapid evaluation and treatment are needed to improve outcomes.
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
The document discusses the development and goals of Acute Oncology Services (AOS) in hospitals with emergency departments and acute admitting beds. It describes the components of an AOS, including rapid oncology reviews within 24 hours of admission, guidance on managing neutropenic sepsis and metastatic spinal cord compression (MSCC), and oncology teams to provide treatment-related complication management. Key aims of an AOS are better communication, increased safety, and improved patient experience. The document then focuses on the AOS at UHL, its structure and cases managed, with emphasis on managing carcinoma of unknown primary, neutropenic sepsis, and MSCC.
This document summarizes a seminar on invasive and non-invasive hemodynamic monitoring in the intensive care unit (ICU). It discusses various monitoring techniques including clinical parameters, blood pressure, echocardiography, esophageal Doppler monitoring, gastric tonometry, central venous pressure, and pulmonary artery catheters. For each method, it covers principles of measurement, indications, limitations, evidence, and clinical applications in critically ill patients. The document emphasizes that hemodynamic monitoring should improve outcomes when coupled with effective treatments, and intensive care physicians should be trained in goal-directed echocardiography.
2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"ASIP Santé
Présentation d'un outil de télésurveillance médicale à domicile de patients atteints de broncho-pneumopathie chronique obstructive (COPD Briefcase)
Anne DICHMANN-SORKNAES, Universitaire d’Odense au Danemark - COPD Briefcase
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
This document provides information about the National Emergency Laparotomy Audit (NELA) and some key performance metrics for emergency bowel surgery cases at Lewisham and Greenwich NHS Trust for the period of April to June 2022. It summarizes that 100% of high-risk cases received consultant-led care, all high-risk patients went to HDU/ITU post-op, and the best practice tariff was achieved. It encourages clinicians to risk score patients pre-operatively, consider recruiting eligible patients to the FLO-ELA trial, and provides contact details for the research team. It also reviews trauma-related services including out of hours orthopedic reviews, fascia iliaca blocks, and regional anesthesia training opportunities
This document provides summaries of emergency radiotherapy treatments for various conditions including brain metastasis, spinal cord compression, superior vena cava obstruction, and airway obstruction. It describes the epidemiology, clinical presentation, imaging, prognosis, and management recommendations for each condition through radiotherapy, surgery, chemotherapy, and supportive care. The key information presented includes indications for and benefits of different radiotherapy fractionation schedules, corticosteroid use, and the importance of timely intervention for conditions causing neurological deficits or obstruction.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). These non-drug therapies can help reduce seizure frequency or render patients completely seizure-free for those with drug-resistant epilepsy.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). The document outlines selection criteria for surgery, risks/benefits of different procedures, and success rates.
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
This document provides an agenda and overview for a webinar about Everbridge CareConverge. The webinar will introduce Everbridge and its CareConverge platform, which provides secure clinical communications and collaboration capabilities to help hospitals improve patient care. It will include customer success stories showing how CareConverge has helped reduce emergency department wait times, launch rapid response teams, and enable telehealth consultations. The webinar aims to demonstrate how CareConverge can raise the bar for clinical communications in healthcare organizations.
Memorial University Medical Center (MUMC) implemented a telestroke program in 2011 using telemedicine to provide stroke consultations to regional hospitals. The telestroke program allows neurologists at MUMC to evaluate acute stroke patients, view CT scans, and determine treatment from anywhere via secure videoconferencing. This expansion of neurological care has increased patients' access to specialized stroke treatment, reduced travel times, and improved outcomes. Since launching, MUMC's telestroke program has grown from consulting at 3 regional hospitals to 5 hospitals, treated over 100 patients, and increased the percentage of patients receiving the clot-busting drug tPA from 14% to over 50%.
This document summarizes MRF's healthcare initiative in Malawi to improve recognition and treatment of meningitis at the primary health level. The initiative developed a triage system using a mobile health tool to classify patients into emergency, priority, and queue categories. The triage system was implemented in 5 primary health clinics in Blantyre, where it led to quicker patient wait times and improved teamwork among health staff. While over 60% of referred patients did not reach the tertiary hospital, the triage system accurately classified patients and showed potential to strengthen primary healthcare responses to illness in Malawi when scaled up.
Abstract del Dr. Hector Ferral acerca del manejo endovascular de la CCSVI en pacientes portadores de Esclerosis Múltiple.
El Dr. Ferral se licenció en Medicina en la ciudad de Mexico, Universidad Anahuac (1979-1985)
Residencia en Medicina Interna: Instituto nacional de Nutricion 1986-1988
Residencia en Radiologia: Instituto nacional de Nutrición: 1988-1991
Fellowship en Intervencionismo: Universidad de Minnesota, Minneapolis : 1991-1993
Attending, Profesor asociado: Lousiana State University, New Orleans: 1995-2000
Attending: Profesor Asociado: University of Texas, San Antonio: 2000-2003
Attending: Profesor de Radiologia: Jefe del Servicio de Intervencionismo, Rush University, Chicago: 2004-2011
Attending: North Shore University: Evanston, Chicago Dic. 2011 a la fecha
más información en www.cdyte.com
Dr Chong Shu Ling - Paediatric head injuryRahul Goswami
The document discusses the management of a 7-year-old girl who presented to the emergency department after being hit by a taxi while crossing the road. On examination, she was crying and oriented but became agitated and drowsy. Her GCS score was assessed and she displayed abnormal flexion in response to pain. The document discusses various clinical decision rules for determining which pediatric patients with head injuries require CT imaging, including the CHALICE, PECARN, and CATCH rules. It considers the risks of radiation exposure from CT scans for children and how to balance these risks with clinical need.
early goal direct therapy by emanuail revierDrJoharAljohar
This document defines the spectrum of sepsis and outlines the principles of early goal directed therapy. It describes sepsis as infection plus SIRS, severe sepsis as sepsis with organ dysfunction, and septic shock as sepsis with hypotension refractory to fluid resuscitation. The key goals of early goal directed therapy are to optimize cardiac output and oxygen delivery through fluid administration, vasopressors, inotropes, and blood transfusion as needed to achieve targets of mean arterial pressure, central venous pressure, urine output, lactate clearance, and central venous oxygen saturation of 70% or greater. Achieving these goals through aggressive early resuscitation and treatment can significantly reduce mortality in severe sepsis and septic shock.
This document discusses the role of neurointensivists in neurosurgical care and training. It describes neurocritical care as a subspecialty focused on comprehensive care of critically ill neurological patients. It reviews the requirements for board certification in neurocritical care, which was first offered in 2007. It also discusses how neurointensivists can be involved in neurosurgical residency training, such as collaborating on didactic sessions and ensuring adequate intensive care unit exposure for residents.
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This study evaluated the diagnostic utility and cost-effectiveness of using a handheld nerve conduction test device to test for carpal tunnel syndrome at a district general hospital. Over 9 months, 141 patients suspected of having carpal tunnel syndrome were tested using the handheld device. The results agreed with traditional nerve conduction studies in 88% of cases. Using the handheld device led to significant cost savings of £16,850 and reduced waiting times. However, 18 patients required further testing, indicating limitations and that traditional testing is still needed if other diagnoses are suspected beyond carpal tunnel syndrome.
This document discusses the management of acute ischemic stroke. It begins by outlining the magnitude of stroke as a problem in India and defines what constitutes a stroke. It then discusses the concepts of penumbra and the importance of short door-to-needle times for thrombolysis. The standard of care for acute ischemic stroke involves rapid evaluation, neuroimaging, ruling out contraindications to thrombolysis, and administration of IV alteplase within 4.5 hours of symptom onset. Barriers to effective stroke treatment in India include delays in recognition of symptoms, reaching care, and administering thrombolysis. Public education on stroke signs and rapid evaluation and treatment are needed to improve outcomes.
This document discusses the management of acute ischemic stroke. It begins by outlining the magnitude of stroke as a problem in India and defines what constitutes a stroke. It then discusses the concepts of penumbra and the importance of short door-to-needle times for thrombolysis. The standard of care for acute ischemic stroke involves rapid evaluation, neuroimaging, ruling out contraindications to thrombolysis, and administration of IV alteplase within 4.5 hours of symptom onset. Barriers to effective stroke treatment in India include delays in recognition of symptoms, reaching care, and administering thrombolysis. Public education on stroke signs and rapid evaluation and treatment are needed to improve outcomes.
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
The document discusses the development and goals of Acute Oncology Services (AOS) in hospitals with emergency departments and acute admitting beds. It describes the components of an AOS, including rapid oncology reviews within 24 hours of admission, guidance on managing neutropenic sepsis and metastatic spinal cord compression (MSCC), and oncology teams to provide treatment-related complication management. Key aims of an AOS are better communication, increased safety, and improved patient experience. The document then focuses on the AOS at UHL, its structure and cases managed, with emphasis on managing carcinoma of unknown primary, neutropenic sepsis, and MSCC.
This document summarizes a seminar on invasive and non-invasive hemodynamic monitoring in the intensive care unit (ICU). It discusses various monitoring techniques including clinical parameters, blood pressure, echocardiography, esophageal Doppler monitoring, gastric tonometry, central venous pressure, and pulmonary artery catheters. For each method, it covers principles of measurement, indications, limitations, evidence, and clinical applications in critically ill patients. The document emphasizes that hemodynamic monitoring should improve outcomes when coupled with effective treatments, and intensive care physicians should be trained in goal-directed echocardiography.
2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"ASIP Santé
Présentation d'un outil de télésurveillance médicale à domicile de patients atteints de broncho-pneumopathie chronique obstructive (COPD Briefcase)
Anne DICHMANN-SORKNAES, Universitaire d’Odense au Danemark - COPD Briefcase
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
This document provides information about the National Emergency Laparotomy Audit (NELA) and some key performance metrics for emergency bowel surgery cases at Lewisham and Greenwich NHS Trust for the period of April to June 2022. It summarizes that 100% of high-risk cases received consultant-led care, all high-risk patients went to HDU/ITU post-op, and the best practice tariff was achieved. It encourages clinicians to risk score patients pre-operatively, consider recruiting eligible patients to the FLO-ELA trial, and provides contact details for the research team. It also reviews trauma-related services including out of hours orthopedic reviews, fascia iliaca blocks, and regional anesthesia training opportunities
This document provides summaries of emergency radiotherapy treatments for various conditions including brain metastasis, spinal cord compression, superior vena cava obstruction, and airway obstruction. It describes the epidemiology, clinical presentation, imaging, prognosis, and management recommendations for each condition through radiotherapy, surgery, chemotherapy, and supportive care. The key information presented includes indications for and benefits of different radiotherapy fractionation schedules, corticosteroid use, and the importance of timely intervention for conditions causing neurological deficits or obstruction.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). These non-drug therapies can help reduce seizure frequency or render patients completely seizure-free for those with drug-resistant epilepsy.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). The document outlines selection criteria for surgery, risks/benefits of different procedures, and success rates.
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
This document provides an agenda and overview for a webinar about Everbridge CareConverge. The webinar will introduce Everbridge and its CareConverge platform, which provides secure clinical communications and collaboration capabilities to help hospitals improve patient care. It will include customer success stories showing how CareConverge has helped reduce emergency department wait times, launch rapid response teams, and enable telehealth consultations. The webinar aims to demonstrate how CareConverge can raise the bar for clinical communications in healthcare organizations.
Memorial University Medical Center (MUMC) implemented a telestroke program in 2011 using telemedicine to provide stroke consultations to regional hospitals. The telestroke program allows neurologists at MUMC to evaluate acute stroke patients, view CT scans, and determine treatment from anywhere via secure videoconferencing. This expansion of neurological care has increased patients' access to specialized stroke treatment, reduced travel times, and improved outcomes. Since launching, MUMC's telestroke program has grown from consulting at 3 regional hospitals to 5 hospitals, treated over 100 patients, and increased the percentage of patients receiving the clot-busting drug tPA from 14% to over 50%.
This document summarizes MRF's healthcare initiative in Malawi to improve recognition and treatment of meningitis at the primary health level. The initiative developed a triage system using a mobile health tool to classify patients into emergency, priority, and queue categories. The triage system was implemented in 5 primary health clinics in Blantyre, where it led to quicker patient wait times and improved teamwork among health staff. While over 60% of referred patients did not reach the tertiary hospital, the triage system accurately classified patients and showed potential to strengthen primary healthcare responses to illness in Malawi when scaled up.
Abstract del Dr. Hector Ferral acerca del manejo endovascular de la CCSVI en pacientes portadores de Esclerosis Múltiple.
El Dr. Ferral se licenció en Medicina en la ciudad de Mexico, Universidad Anahuac (1979-1985)
Residencia en Medicina Interna: Instituto nacional de Nutricion 1986-1988
Residencia en Radiologia: Instituto nacional de Nutrición: 1988-1991
Fellowship en Intervencionismo: Universidad de Minnesota, Minneapolis : 1991-1993
Attending, Profesor asociado: Lousiana State University, New Orleans: 1995-2000
Attending: Profesor Asociado: University of Texas, San Antonio: 2000-2003
Attending: Profesor de Radiologia: Jefe del Servicio de Intervencionismo, Rush University, Chicago: 2004-2011
Attending: North Shore University: Evanston, Chicago Dic. 2011 a la fecha
más información en www.cdyte.com
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7_telemedicine services _panel_pptx.pptx
1. Prasha Govindarajan, MD, Associate Professor of Emergency Medicine Stanford
University School of Medicine
David Tong, MD, Director, Telemedicine Network, California Pacific Medical Center
George Oldham, MD, Medical Director, Emergency Department, Dignity Health
Sequoia Hospital
Jeffrey Klingman, MD, Neurologist, Kaiser Permanente
Jenny Im, RN, Stroke Coordinator, Mills-Peninsula Health Services
Jake Jung, PharmD, In-patient Pharmacy Supervisor, Kaiser Permanente Redwood
City Medical Center
SAN MATEO COUNTY 2016 STROKE SYMPOSIUM: A MATTER OF TIME
Implementation of Telemedicine Services: Trials,
Tribulations and Success
3. Background
• Time is brain – Stroke is time-sensitive like
OHCA, multi-organ trauma and ST elevation
MI.
• Prehospital care is an important component
of acute stroke treatment pathways
• Stroke scales perform better in validation
studies than in real time
• Innovative methods to improve stroke care
4. Telemedicine
• Mobile Stroke Units is a novel concept but has
limited generalizability
• Another innovative concept is extending
telemedicine into the field
• La Monte et al. proposed this in early 2000’s
• Technology was primitive but results showed
good reliability and agreement between
providers
5. Telemedicine
• PreSSUB – Prehospital telemedicine group from
Brussels, BE
• The goals of this study were similar to ours
– Recognition of stroke
– Assessment of stroke severity
– Collection key information from patients that may
influence treatment decisions
– Large Vessel Occlusion
– Communication with neurologist and pre-notification
6. Telemedicine
Pilot study tested on healthy volunteers
• Stability of prehospital wireless connectivity
• Developed and pilot tested a simpler prehospital
stroke scale called UTSS
• Multi-lingual decision support system (Dutch, English
and French)
• Transmission of a prehospital record electronically to
the vascular neurologist
• Prenotification through a text messaging system
7. Telemedicine
• Results showed a median of 9 minutes for the
telecommunication
• Stroke neurologists identified 12 stroke cases
using teleconsultation. 10 of those were
identified as stroke in the hospital
• 100% transmission of prehospital case reports
• Overall, demonstrated successful results in
use of prehospital telemedicine
10. Stroke Teleneurology Success Case Study
Atypical Presentation of Cerebral Vascular Issue
• 69 yo male LKWT 9:00pm awoke at 2:45 am with
profound confusion, agitation, difficulty speaking,
and mild R sided weakness.
• Recent Dx of URI and started on Cipro the day before.
• Per wife, the patient was completely normal and
without any complaints when he went to bed at 9:00
pm.
11. • 911 called. AMS but no local deficits. Medics
note a glucose of 76 and give glucola without
improvement.
13. • BP 102/61, HR 73, RR 19, T 36.3, Sat 100% RA
• Confused, agitated, not following commands, 1 or 2
word responses that seem appropriate.
• Did recognize ERMD and wife. EOMI,? sl R facial
droop, = grips, Nl motor and sensory all Ext.
14. • Labs all normal,
• Urine drug tox Negative
• EKG: NSR 77, NS ST-T wave abnormalities
15. • Non con head CT:
• No ICH, No evidence of acute ischemia or infarct.
• Chronic small vessel ischemic disease within the
subcortical and periventricular white matter.
16. • Tele-neurology Exam:
• NIHSS score: 7
• 1b LOC questions: 2, 1c LOC Commands: 2, 5b Motor R
arm: 1 (drift), 9 Best Language: 2 (severe aphasia)
• CT EVAl: L M2 hyperdense sign. CTA not done
• Note a candidate for t-PA ( LNWT now 6 hours)
• Clot retrieval still an option
17. • Transfer to SUH
• MR showed L MCA clot
• Successful clot retrieval
19. Benefits of Teleneurology for Stroke Patients at
Dignity Health Sequoia Hospital
24/7 neurological consultation available
All suspected stroke patients receive teleneurology consultation
Response time is excellent- had to work collaboratively with
teleneurology as to the timing of the call to the teleneurologist for a
consultation to minimize delays on both ends
Teleneurologists assist in managing the process for transfer to Stanford
University Hospital for endovascular treatment or neurosurgery
100% up time with robot and network
Teleneurology consultation report available in the medical record within
30 minutes of consultation
Data retrieval for statistical analysis
20. KPNC Stroke EXPRESS
EXpediting the PRocess of Evaluating & Stopping Stroke
Role of the Teleneurologist
20
Jeffrey G. Klingman, MD
21. Time is Brain
2 Million nerve cells die per
minute
Better outcomes with faster
Door to Needle
Better outcomes with
endovascular treatment of
LVO’s
Better outcomes with faster
endovascular treatment
Helsinki Model
22. Time is brain : The key to speed…
Key components = early notification and involvement of stroke
neurologist
Don’t room – straight to CT
Alteplase in CT
Problem: small volumes cannot justify in house stroke neurologist
24. Serial vs. parallel processes
Patient arrival
RN evaluation
Stroke alert
called
ED doctor
evaluation
CT ordered
Lab drawn
Transport to
CT
Roomed in
ED
CT done
Transport
back to ED
CT read and
called to ED
doc
Call to Neuro Alteplase
ordered
Alteplase
prepared
Lab Resulted
Alteplase
pushed
Back to CT for
CTA
CTA done
CTA resulted
Ambulance
called
Ambulance
arrival
Transport
Stroke alert
called
Patient arrival
Team evaluation in
ambulance bay: ED,
RN, Stroke
Neurology
Alteplase, CT,
CT, CTA<
ambulance
ordered
Transport to
CT
Alteplase
prepared
CT read and
called to
teleneurology
Alteplase
given (in CT)
CTA done
Ambulance
arrival
Transport
OLD: Serial NEW: Parallel
Stroke
Neurologist
involvement
Neurologist
involvement
25. Tele-technology needs for stroke
Instant on
Neurologist control of pan, scan, and zoom
Good sound
Mobile
26. Teleneurology “Hub”
Small core group of stroke specialist neurologists who are
involved in all stroke alerts
Remote exam by teleneurologists with RN / ED MD assistance
Active 7am – midnight 7 days a week (rate very low in “off” hours)
Neurologist orders the alteplase
27. Step One: Rapid assessment on arrival with video
• Call to Neurologist via central 800 number - neurologist activates tele-presence unit
• Clinical assessment and exam by stroke neurologist by video
• Clinical assessment by ED physician
• IV access
• Lab
• Blood sugar testing
• INR if on warfarin
• Discussion of alteplase / CTA risks, benefits, alternatives
• IV alteplase mixing ordered as soon as possible (allows time for mixing)
• Call on / off stroke alert based on clinical assessment
• Checklist / time out before leaving for CT
28. Step 2: Direct to CT/CTA after tPA is determined
appropriate
Direct to CT scanner –
Cart and teleneuro goes to CT
Alteplase in CT scanner
if no CT contraindication
Second exam, team safety checklist
CTA completed directly after
CT and Alteplase initiation
28
29. Role of teleneurology in the process
Initial history and exam
Discussion of alteplase and CTA
Orders alteplase mixing
Agreement between ED doc and stroke neurologist
CT done : read by neuroradiologist and teleneurologist
Second exam, “enforces” team safety checklist
Orders alteplase administration in CT scanner
Stays on video while CTA
Neuroradiology contacts teleneurologist with results
Teleneurologists contacts receiving center MD if LVO
29
30. Step 3: Rapid transfer
30
• Identification of preferred
endovascular centers and contacts
• One call system
• Imaging access
• Direct to cath lab
• Ambulance transfer hub contacted
upon ordering of t-PA
• LVO likely: order ambulance
• LVO not so likely: notify
• LVO identified : keep coming
• LVO ruled out : never mind
• Ongoing time and outcome
tracking
32. First quarter 2015
Median = 54 minutes,
3% < 30 minutes
38 cases per month
First quarter 2016
Median = 32 minutes,
45% < 30 minutes
80 cases per month
Results: All Facilities
34. Complications?
2014 symptomatic bleed rate : 4.5%
2016 symptomatic bleed rate: 4.3%
Rate without EST 5/216 = 2.3%
Bleed with death no EST = 0.4% (non KP EXPRESS)
35. On behalf of the KPNC Stroke FORCE
(Fast Operating Remote Cerebrovascular Experts)
36. MPHS Telestroke and ED
Workflow
Patient
presents to the
ED with
stroke-like
symptoms
Clinician
initiates
stroke alert
Is the Last
Known Well
< 6 hours?
Yes
No ED MD evaluates
conducts usual
workup
IS CVA in
differentia
l?
Consult
CPMC Stroke
Neurology
and treat as
recommend
ed
Patient is
either
admitted,
discharged ,
or
transferred
Administer TPA
Assess other
treatment options.
Patient is either
admitted,
discharged , or
transferred
Patient is
either
transferre
d or
discharge
d
Is tPA
recommen
ded?
Decision
to admit
Patient is
transferred
Patient is
admitted
Patient is
admitted
Is the case
complex?
Should the patient
be transferred?
ED contacts
hospitalist and the
hospitalist consults
local neurology
ED consults local
neurologist
Contact hospitalist
for admission
Continue
workup
No
Yes
Is CVA in
differentia
l?
Consult
CPMC Stroke
Neurology
and treat as
recommende
d
Continue
workup
No
Yes
No
Yes
No
Yes
No
Yes
Yes
No
V1 Stroke Team_9.2015
37. Tele Medicine Program Timeline
2015 June July Aug Sept Oct Nov
Tele medicine
Decision
Privileges and
credentialing
Contract and
Equipment
Workflows
Marketing
and
Communicati
ons
Policies
Department
Education
Discussions with
local Neurologist ,
Telemedicine and
Administration
Application process for 7 stroke
neurologists
Tele medicine contract
agreement, equipment
delivery and testing
Physician and
Community
Forums,
Newsletters
ED, Stroke Neurology,
Community Neurology,
Radiology and
Hospitalist workflow
St
af
f
Tr
ai
ni
n
Tele
Medicine
Policy
approval
38. Tele Medicine Program Timeline
2015 June July Aug Sept Oct Nov
Tele medicine
Decision
Privileges and
credentialing
Contract and
Equipment
Workflows
Marketing and
Communications
Policies
Department
Education
Discussions with local
Neurologist , Telemedicine
and Administration
Application process for 7 stroke neurologists
Tele medicine contract agreement,
equipment delivery and testing
Physician and Community
Forums, Newsletters
ED, Stroke Neurology, Community
Neurology, Radiology and Hospitalist
workflow
Staff
Training
Tele Medicine Policy
approval
39. Changing Contraindications
for t-PA in Acute Stroke:
Review of 20 Years Since NINDS
Current Cardiology Reports (2015) 17:81
Sarah Parker ; Yasmin Ali
Collection on Stroke
40. Origin of Original Contraindications for IV t-PA
Taken directly from the inclusion and exclusion criteria used in the
National Institute of Neurological Disorders and Stroke (NINDS) trial
Why?
1. To reduce possible adverse events
2. To avoid including patients with stroke mimics in the study population
41.
42. Comparison of Contraindications in t-PA 2015
Label and Previous t-PA Labeling
t-PA Feb 2015 labeling
General
• Active internal bleeding
• Recent intracranial or intraspinal
surgery or serious head trauma
• Intracranial conditions that may
increase the risk of bleeding
• Bleeding diathesis
• Current severe uncontrolled HTN
Acute Ischemic Stroke
• Current intracranial hemorrhage
• Subarachnoid hemorrhage
Previous t-PA labeling
• History of intracranial hemorrhage
• Suspicion of subarachnoid hemorrhage
• Active internal bleeding
• Recent intracranial or intraspinal
surgery
• Significant head trauma or prior stroke
in previous 3 months
• Intracranial neoplasm, arteriovenous
malformation, or aneurysm
• Elevated blood pressure
(SBP > 185 mmHg or DBP > 110 mmHg)
• Acute diathesis
• Seizure at onset of stroke
All contraindications designed to eliminate stroke mimics have now been removed
43. What’s new?
• Conditions which the medication had not
been studied in are no longer automatically
considered as contraindications
• Contraindications designed to eliminate
stroke mimics have now been removed
New revision to the saying…
“absence of evidence is not evidence of absence”
“absence of evidence of a risk is not evidence of the risk”
Activase Feb 2015 labeling
General
• Active internal bleeding
• Recent intracranial or intraspinal surgery or
serious head trauma
• Intracranial conditions that may increase the
risk of bleeding
• Bleeding diathesis
• Current severe uncontrolled HTN
Acute Ischemic Stroke
• Current intracranial hemorrhage
• Subarachnoid hemorrhage
44. Evidence: Use of IV t-PA in patients with
contraindications
Study Conclusion
Kvistad CE, Logallo N, Thomassen L, et al. Safety of off-
label stroke treatment with tissue plasminogen activator.
Acta Neurol Scand. 2013;128:48–53.
When compared to patients who did not have any
contraindications to IV t-PA and received
treatment, they found that there was no
significant difference in the rate of symptomatic
intracerebral hemorrhage (sICH).
Guillian M, Alonso-Canovas J, Carcia-Caldentey V,
et al. Off-label intravenous thrombolysis in acute
stroke. Eur J Neurol. 2012;19: 390–4.
No difference in the rates of sICH or severe
systemic bleeding
Nadeau JO, Shi S, Fang J, et al. tPA use for stroke
in the registry of the Canadian stroke network.
Can J Neurol Sci. 2005;32: 433–9.
Patients who had contraindications did not have
higher rates of sICH or mortality
Frank B, Grotta JC, Alexandrov AV, et al.
Thrombolysis in stroke despite contraindications
or warnings? Stroke. 2013;44:727–33
When compared to patients who did not receive
IV t-PA, patients with age >80, history of previous
stroke and diabetes, and NIHSS score >22 had
better outcome at 3 months
45. Evidence: Use of IV t-PA in mild or rapidly improving
symptoms
Study Conclusion
Rajajee V, Kidwell C, Starkman S, et al. Early MRI and
outcomes of untreated patients with mild or improving
ischemic stroke. Neurology. 2006;67:980–4.
Patients who did not receive IV t-PA due to mild
or rapidly improving symptoms had poorer
outcomes compared to those who received IV t-
PA
Smith EE, AbdullahAR, Petkovska I, et al. Poor
outcomes in patients who do not receive intravenous
tissue plasminogen activator because of mild or
improving ischemic stroke. Stroke. 2005;36:2497–9. Patients who did not receive IV t-PA due to mild
or rapidly improving symptoms were not able to
be discharged home due to their deficits
compared to those who received IV t-PA
Smith EE, Fonarow GC, Reeves MJ, et al. Outcomes in
mild or rapidly improving stroke not treated with
intravenous recombinant tissue-type plasminogen
activator. Stroke. 2011;42:3110–5
Baumann CR, Baumgartner RW,Gandjour J, et al.Good
outcomes in ischemic stroke patients treated with
intravenous thrombolysis despite regressing
neurological symptoms. Stroke. 2006;37:1332–3.
Patients who received IV t-PA for strokes with
mild or rapidly improving symptoms did not
experience sICH
46. Evidence: Use of IV t-PA in patients with recent
ischemic stroke
Study Conclusion
Alhazzaa M, Sharma M, Blacquiere D, et al.
Thrombolysis despite recent stroke.
Stroke. 2013;44:1736–8
Patients who had a previous stroke within
3 months of receiving IV t-PA did not
experience sICH.
Meretoja A, Putaala J, Tatlisumak T, et al.
Off-label thrombolysis is not associated
with poor outcome in patients with stroke.
Stroke. 2010;41:1450–8
47. Conclusion
• Original IV t-PA contraindications were largely based on inclusion
and exclusion criteria used in the NINDS trial
• Latest contraindication revisions (Feb 2015) will increase the number
of patient eligibility for treatment
• As always, there is no substitute for clinical judgment
Editor's Notes
You heard this morning about the studies that are ongoing in prehospital telemedicine. I would like to use the panel time to present the rationale for expanding telemedicine in the field.
La Monte proposed the model however parts of it were primitive compared to the technology we have today.
Decided to redesign acute stroke care to really maximize performance
Rapid treatment is perhaps most important improvement you can make
What about language?
What about inpatients?
National Institute of Neurological Disorders and Stroke (NINDS) trail
Contraindications from Previous Activase Labeling taken from 2013 AHA/ASA Guidelines for the Early Management of patients with Acute Ischemic Stroke
Contraindications from Previous Activase Labeling taken from 2013 AHA/ASA Guidelines for the Early Management of patients with Acute Ischemic Stroke
Comparing these new contraindications to the previous list, all of the contraindications designed to eliminate stroke mimics have now been removed.
Patients who received t-PA despite having contraindications
Patients who received t-PA despite having contraindications
Patients who received t-PA despite having contraindications