Rispondi Annulla risposta
This site uses Akismet to reduce spam. Learn how your comment data is processed.
Follow MEDEST on Twitter
- The MEDEST118 Daily is out! paper.li/MEDEST118/1407… Stories via @H2OhTwist @SAIRABT @annakirbybailey #foamed #meded 1 hour ago
- Appropriate Needle Length for Emergent Pediatric Needle Thoracostomy Utilizing Computed Tomography tandfonline.com/doi/abs/10.108… 6 hours ago
- Pediatric Needle Decompression - What Size Needle? journalfeed.org/article-a-day/… 6 hours ago
- facebook.com/story.php?stor… 18 hours ago
- facebook.com/story.php?stor… 18 hours ago
Articoli Recenti
- Syncope. We need a prehospital pathway. 18 febbraio 2019
- 1 Year in Review. Trauma papers. 3 gennaio 2019
- 1 Year in Review. Airway management. 27 dicembre 2018
- Clinal Myths and Scientific Truth about heart failure/pulmonary edema management in prehospital setting. 18 dicembre 2018
- 1 Year in Review. 2018 Guidelines you must know. 13 dicembre 2018
- Social media & aggiornamento. Dacci il tuo parere! 18 ottobre 2018
- CPR in TCA: A TLA PSA 12 ottobre 2018
The MEDEST on line News
Paperli.PaperWidget.Show({pid: '71aba46f-dee1-4148-93c6-c1537be7ba8a', width: 200, background: '#FB0000'})
Archivi
MyTweet
- The MEDEST118 Daily is out! paper.li/MEDEST118/1407… Stories via @H2OhTwist @SAIRABT @annakirbybailey #foamed #meded 1 hour ago
- Appropriate Needle Length for Emergent Pediatric Needle Thoracostomy Utilizing Computed Tomography tandfonline.com/doi/abs/10.108… 6 hours ago
- Pediatric Needle Decompression - What Size Needle? journalfeed.org/article-a-day/… 6 hours ago
- facebook.com/story.php?stor… 18 hours ago
- facebook.com/story.php?stor… 18 hours ago
- facebook.com/story.php?stor… 19 hours ago
Favourites FOAMED Blogs
- ALL Ohio EM
- Triggerlab
- thinking critical care
- urgentcareultrasound
- MariaLuisaRuberto.com
- Critical Care Northampton
- OHCA research
- SonoStuff
- phemcast
- First10EM
- Songs or Stories
- airwayNautics
- resusNautics
- EMSPOCUS
- Life in the Fast Lane • LITFL • Medical Blog
- emDOCs.net - Emergency Medicine Education
- The Collective
- Dave on Airways
- FOAMcast
- Broome Docs
- St.Emlyn's
- BoringEM
- "CardioOnline"Basic and Advanced Cardiovascular medicine" Cariology" concepts and Review -Dr.Nabil Paktin,MD.FACC.دکتـور نبــــیل "پاکطــــین
- DOWNSTAIRS CARE OUT THERE BLOG
- EmergencyPedia
- Little Medic
- Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds
- Prehospital Emergency Medicine Blog
- Italy Customized Travel Blog
- GoogleFOAM
- EM Lyceum
- Pediatric EM Morsels
- academiclifeinem.com/
- EM Pills
- AmboFOAM
- FOAM4GP
- Rural Doctors Net
- Auckland HEMS
- ECHOARTE
- MEDEST
- ruralflyingdoc
- EM Basic
- KI Doc
- Emergency Live
- AMP EM
- www.podcastingformedicalprofessionals.com
- Academic Life in Emergency Medicine
- Comments on: Homepage
- Greater Sydney Area HEMS
Scrivi a MEDEST
Le tue opinioni sono il nostro valore aggiunto!
New 2015 ACEP Clinical policy on ischemic stroke downgrade tPA within first 3 hours to a Level B recommendation (and other condsiderations about this policy).
24 LugOn June 2015 ACEP updated the 2013 policy on ischemic stroke treatment.
The 2013 policy graded the tPA administration within 3 hours as a Level A recommendation and tPA administration between 3 to 4.5 hours as Level B recommendation
2013 ACEP Clinical policy on ischemic stroke
In Jan 2015 ACEP published a Draft about the update of the 2013 clinical policy based on 2 critical questions:
Is IV tPA safe and effective for patients with acute ischemic stroke if given within 3 hours of symptom onset?
Is IV tPA safe and effective for patients with acute ischemic stroke treated between 3 to 4.5 hours after symptom onset?
January 2015 Draft about ACEP Clinical policy on ischemic stroke
January 2015 Draft about ACEP Clinical policy on ischemic stroke
In June 2015 the definitive policy was released, based on the same critical questions.
2015 ACEP Clinical policy on ischemic stroke
2015 ACEP Clinical policy on ischemic stroke
Here is the most relevant changes:
Some considerations on evidences supporting the recommendations in this 2015 policy:
What I like about the policy:
What I don’t like about the policy:
Bottom line
I think thrombolysis is a beneficial treatment for a selected group of patients. The available evidences and policies (even this last one) based on time window alone, and not patient centered, don’t clearly indicate which group of patients really benefits from tPA administration.
This 2015 ACEP policy suggests physician to strongly consider the risk (evident)/benefit (maybe) ratio when offering tPA in acute ischemic stroke and to strongly involve patients in the final decision. It also leave the clinician a wide range of choice to decide which is the right patient to treat with tPA.
“When considering administration of IV tPA for a patient with acute ischemic stroke within 3 hours of stroke symptom onset, the physician and patient (and/or the surrogate) should weigh the potential benefit in terms of long-term functional outcome against the increased risk of sICH while recognizing that IV tPA does not alter 90-day mortality.“
Important readings:
Litterature classification schema of Evidence Class
Recommendation Level Classification
References:
Unmissible resources:
FOAMcastini – ACEP tPA Clinical Policy part 1
FOAMcastini – ACEP tPA Clinical Policy part 2
EMLITOFNOTE The Wholesale Revision of ACEP’s tPA Clinical Policy Posted by Ryan Radecki
Condividi:
Mi piace:
Correlati