A Sensible Approach to TIA P1

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Mike J., M.D. -

Haven't listened to part 2 yet, but does ECHO have any utility? Currently we admit for Echo, monitoring and carotid US, most also get MRI. I can get most of these studies acutely but the echo is the hard one.

David H., M.D. (@BritFltDoc) -

Dr Berg,
Thank you for a great discussion on this topic. I was interested in your views on getting an MRI and MRA from the ED as a risk stratification tool. In an era of increased scrutiny on ED length of stay, this is interesting. MR is one of those things that is readily available at very only specific times. Even if it is daytime, Mon-Fri, it is likely a patient will need to wait in the ED for some time for an opening to get this done (since they are asymptomatic can't justify bumping other waiting patients). If we want to add quicker diagnostic data to help risk stratify, wouldn't a CT angio of the neck be more efficient, and help identify those with high grade carotid artery stenosis? So an expedited ED work up could get: EKG and telemetry monitoring, and CT Head and CTA neck. That leaves the echo, that you state could be done as an outpatient.
Or we could be really efficient, and after clinically ensuring no residual deficit is present, admit to observation status for Medicine to do the risk stratification in a goal of less than 23 hours, and keep the ED flow moving and LOS short ?

Ian L., Dr -

A mnemonic is BRAIN -Brain deficit Risks eg AF A Asprin and anticoagulants I imaging N natural course vs intervention

thomas s. -

Is there a PDF of the actual TIA ADP on PDF or otherwise?
Thanks,
Tom Sichi

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