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EMA, Swadron, Herbert & Bundt Cake Goodness!

Low NIH Stroke Patients

Rob Orman, MD and Jon Schrock, MD
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16:26
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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01:50

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Tags Ischemic Stroke · Neurology/Stroke · Reperfusion · Stroke
EM:RAP 2017 October Written Summary 608 KB - PDF

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Michael P. -

You mentioned your quote for explaining the risk of sICH with tPA that you say to your patients being from UC San Diego. Can you explain this quote further? Is this from a certain study? I would like to consider using this example but I'd like to know where it derives from. Thanks!

Jon S., MD -

Micheal P.

Here is a link to the figure I am referring to....

https://www.google.com/search?biw=1920&bih=974&tbm=isch&sa=1&q=stroke+consent+image&oq=stroke+consent+image&gs_l=psy-ab.3...17373.17373.0.17531.1.1.0.0.0.0.92.92.1.1.0....0...1.1.64.psy-ab..0.0.0....0.LLq_vNgzH4E#imgrc=s_6p8FkUFGNWeM:

If you cannot find it please email me at jschrock@metrohealth.org

thanks
jon

Mark W., D.O. -

32-35 out of 100 will have show benefit at 3 months with tPA? I thought NINDs showed just 12% benefit with 6% bleed. Is there another newer study confirming NINDs results or showing better numbers? It wouldn't be the last time I was behind on newer studies.

Thanks, Mark

Jon S., MD -

Mark W
Yes the ninds trial shows ARR of 12% so NNT = 8 but it is not that simple. The sooner you treat after symptoms onset the better they do so if they show up within 30 minutes of symptom onset the ARR would be higher so the NNT would be lower.

thanks
jon

Geoffrey M. -

I need some clarification. Mild strokes - this seems to be based on your score rather than on the underlying pathology. Are you meaning these patients who present within the 3 hour window get lytics based on clinical findings or do they all get imaging? I would have thought they all would have been imaged and mild would be irrelevant if there was a major vessel occlusion. The trial that was discontinued seems a shame as I would have thought getting the answer to who benefits would be ideal. The earlier lytic trials seemed to indicate poor outcomes with lytics.

Jon S., MD -

Geoffrey M
PRISMS described mild strokes as ones with an NIHSS of less than 6. Also they had to be strokes that the doc thought would be too mild to warrant tpa treatment. If the doc said they were not treating with tpa then we could approach them for enrollment. They may or may not have had a CTA of the head. I expect we may see results from the trial in late January of 2018.... you can google prisms to get to clinical trials.gov to see the inclusion exclusion criteria.
thanks
jon

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EMA, Swadron, Herbert & Bundt Cake Goodness! Full episode audio for MD edition 280:40 min - 391 MB - M4AEM:RAP 2017 October Aussie Edition Australian 30:20 min - 42 MB - MP3EM:RAP 2017 October French Edition Français 24:50 min - 34 MB - MP3EM:RAP 2017 October German Edition Deutsche 58:35 min - 81 MB - MP3EM:RAP 2017 October Spanish Edition Español 77:32 min - 106 MB - MP3EM:RAP 2017 October Canadian Edition Canadian 29:54 min - 41 MB - MP3EM:RAP 2017 October Board Review Answers 100 KB - PDFEM:RAP 2017 October Board Review Questions 85 KB - PDFEM:RAP 2017 October Individual MP3s 172 MB - ZIPEM:RAP 2017 October Spanish Summary 1 MB - PDFEM:RAP 2017 October Written Summary 608 KB - PDF

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