And here we are with the 4th episode of the F.A.R. series. If you accidentally lost the first two episodes you can find them here:

#1 Cardiac Arrest

#2 Airway Management

In this episode we’ll explore the best articles of 2014 about:

Stroke

Before starting we have to declare (if you are not aware of) that MEDEST is quite skeptical about the previous studies that are at the basis of thrombolytic therapy (Lo strano caso del trombolitico nell’ictus cerebrale ischemico, Pubblicate le nuove linee guida AHA/ASA sul trattamento precoce dello Stroke: nessuna nuova ed ancora qulache dubbio!, L’uso del trombolitico nello stroke. Stiamo giocando con la salute dei nostri pazienti?, rt-PA e Stroke: IST-3 l’analisi dei risultati). This can represent a potential bias on the choice of the articles. We also think that the actual evidences, and the consequent guidelines, are strongly influenced by commercial interests and not well supported from evidences that demonstrates how benefits outweight harms. We hope that 2015 will be the first year of a new era for stroke management, an era of well done studies producing strong evidences to achieve good neurological targets in all stroke patients.

In the first part we mention the litterature about thrombolytic therapy

• Thrombolytic Therapy in  Acute Stroke
• Questions about authorisation of alteplase for ischaemic stroke
• Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative
• Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice
• Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials
• Association Between Hyperoxia and Mortality After Stroke- A Multicenter Cohort Study

And then the articles about endovascular therapy:

• A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke
• A research roadmap of future endovascular stroke trials
• Endovascular therapy for acute ischemic stroke is indicated and evidence based: a position statement
• Reperfusion therapies of acute ischemic stroke: potentials and failures
• Stroke- an emphasis on guidelines
• A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
• Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

And now as anticipated in the title the 2015 ACEP Clinical Policy on Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department. Those freshly published guidelines give answer at two of most recurrent questions on stroke treatment:

1. Is IV tPA safe and effective for acute ischemic stroke patients if given within 3 hours of symptom onset?

2. Is IV tPA safe and effective for acute ischemic stroke patients treated between 3 to 4.5 hours after symptom onset?

Download and read the full policy to discover the recommendations made and based on the strength of the available data.

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

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Tag:ACR, advanced airway management, Antiaggregazione, antiplatelets, arresto cardiaco, clinical decision rules, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, litterature review, medicina d'urgenza, prehospital emergency medicine, sindromi coronariche acute, Stroke

And here we are with the 3th episode of the F.A.R. series. If you accidentally lost the first two episodes you can find them here:

#1 Cardiac Arrest

#2 Airway Management

In this episode we’ll explore the best articles of 2014 about:

Trauma

Before approaching specific arguments about trauma here are some fundamental articles to read about new emerging concepts in trauma care. Those are the clinical and physiological bases to understand what is happening in the actual trauma management scene.

• Trauma-Induced Coagulopathy

  • Pre-hospital identification of trauma patients with  early acute coagulopathy and massive bleeding:  results of a prospective non-interventional clinical  trial evaluating the Trauma Induced Coagulopathy  Clinical Score (TICCS)

• Development of a simple algorithm to guide the effective management of traumatic cardiac arrest  (read also Mind of resuscitation in traumatic cardiac arrest)

• Damage Control Resuscitation in Trauma

• The Management of Pediatric Polytrauma: Review

And now let’s go to specific area of interest:

• Spine immobilization

Spine immobilization in trauma is changing.

After years of dogmatic approach to strict spine immobilization for all trauma patients regardless any other factor, is now pretty clear that not all the trauma patients benefits from this all or nothing way of thinking. MEDEST already faced the argument in previous posts (The Death of the Cervical Collar?) as also did some prehospital consensus guidelines (Faculty of Pre-Hospital Care Consensus Statements).

In 2014 many articles treated this topic in a critical and modern way of re-thinking spinal immobilization, in particular the widespread use of cervical collar. The lessons we learned is that:

1. Widespread use of cervical collar in neck trauma has to be carefully evaluated (and even avoided) due to the low incidence of unstable spinal lesions.
2. Routine use of cervical collar is of unclear benefit and supported by weak evidences. A new selective approach has to be implemented based on prehospital clearance protocols.

• Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

• Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma

• Prehospital Use of Cervical Collars in Trauma Patients- A Critical Review

• Comparison of Three Prehospital Cervical Spine Protocols  for Missed Injuries

• Fluids and blood products

What is “revolution” in clinical practice? We don’t have the answer to this dilemma, but what is happening in fluid resuscitation for trauma patients seems likely to be revolutionary. Restrictive strategies and new blood products are the future for the treatment of trauma patients (read also Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?).

• Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients

• Fluid resuscitation in trauma patients- what should we know

• Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

• The Ongoing Debate Between Crystalloid and Colloid

• Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

• Hypotensive Resuscitation

• Trauma and Massive Blood Transfusions

• Is early transfusion of plasma and platelets in higher ratios associated with decreased in-hospital mortality in bleeding patients?

• The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

But much more happened in 2014 about trauma….

Resuscitative throacotomy is now a reality not only “in” but even “out” of hospital, so read all about it

• Resuscitative thoracotomy an update

An evergreen topic is TBI but new concepts are arousing so read here the latest updates

• Critical care management of severe traumatic brain injury in adults

New drugs and new protocols for airway and pain management: a rationale guide to choose the right drug for the right patient.

• Choice of General Anesthetics for Trauma Patients

• Pain   management   in   trauma   patients   in   (pre)hospital   based emergency   care:   Current   practice   versus new guideline

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

Follow MEDEST on Google+

Follow MEDEST on Facebook

Tag:ACR, advanced airway management, Antiaggregazione, antiplatelets, arresto cardiaco, clinical decision rules, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, litterature review, medicina d'urgenza, prehospital emergency medicine, sindromi coronariche acute, Stroke