ฝัง
- เผยแพร่เมื่อ 20 พ.ย. 2024
- An overview of ischemic stroke, including the etiologies, presentation, work-up, and management. Indications for tPA (i.e. alteplase) discussed.
A few references for those who want to learn more...
Complete 2019 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: www.ahajournal...
Thombolytics in stroke - A discussion of the controversy from a neurologist: journals.sagep...
Thrombolytics in stroke - Another neurologist's opinion: journals.heart...
Thrombolytics in stroke - A skeptics review of the literature: first10em.com/...
Thrombolytics in stroke - Another skeptic: www.medscape.c...
These videos are SO clutch! Especially including the non-treatment aspects like consulting PT/OT and getting speech eval etc. First year resident here, and these videos are saving my lifeee
Glad you're finding them helpful!
Fantastic videos! You are such a treasure trove of rich, concise information for us junior doctors. Thank you!!!
I came across one of your videos and since then I’ve been binge watching almost all of the videos in your channel. Thank you!!!
I like your videos so much. I wish I had 10,000 different youtube accounts to add 10000 likes. I want to share a couple of info, I learned through my rotation in Hopkins.
1. Only perfusion dependent strokes (often decided based on MRI appearance) need permissive Hypertension. These are large cerebral strokes, stroke with corresponding ipsilateral carotid stenosis. Brain stem strokes are usually not perfusion dependent.
2. Dual antiplatelet therapy for 3 weeks is indicated for strokes with significant intracranial atherosclerosis
3. A common ER practice is to determine tPA candidate based on NIHSS. This is wrong and an outdated method. As long as there is a clear focal neurologic deficit, other differentials are ruled out, no contraindications to tPa, it should be given.
Thanks for the comment! I too have seen the use of the NIHSS to determine tPA candidacy, but luckily not for a few years.
Thank you so much for the great content. I'd love to see a full-length video exploring the tPA controversy.
I survived A stroke 2years ago. I used to be half paralyze. but now I can move my arms and legs. thank God I can walk again. Follow my page I put all things that I do to help me recover. maybe it can help us survivors.
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Great video as always! Your videos on the cardiac physical exam were amazing and generated lots of interest, in fact Its how i noticed your channel back in the days as a med student. Have you considered making a video/videos on the pulmonary physical exam, including abnormal breath sounds etc? I think it would be useful for mamy people.
Anyway, keep up the good work!
Thanks for watching, and for the comment! I've wanted to make a video on the pulm exam for years, but have never been satisfied with the quality of recorded lung sounds. For some reason, it's harder to get reasonable fidelity than with heart sounds/murmurs.
Thank you so much!!!!!!!!
I thank you very much Dr Strong. I might even learn a new thing from you just today,.
Thank you Dr Strong. It is so compact :) and practical. So comprehensive
Its sad when you are Doctor in a third world country and you hospital doesn't even have a CT scanner or tPa!
I feel u brother
😮
Thank you for your information ❤
Which country is that? Surely you must have at least one ct scanner?
Great lecture
“Our prospectively collected single-center data, coupled with the findings of the comprehensive meta-analysis, underscore the safety of IVT in SMs given the lower risk of symptomatic intracranial hemorrhagic complications compared with IVT- treated patients with subsequently confirmed AIS. Moreover, the pooled rates of sICH and OE in patients with SMs treated with systemic thrombolysis are extremely low (≤0.5%) with narrow 95% CI (not exceeding 2%), whereas almost 9 of 10 patients with SMs treated with intravenous tPA have a FFO at hospital discharge.”
For the study: Safety of Intravenous Thrombolysis in Stroke Mimics Prospective 5-Year Study and Comprehensive Meta-Analysis.
Published by Stroke in 2015.
IVT: Inadvertent intravenous thrombolysis
SMs: Stroke Mimics
AIS: Acute Ischemic Stroke
FFO: Favorable Functional Outcome
This shows the safety of tPA even in stroke mimics
So good
can u make vid on approach to loss of sensation. btw this series is so helpful tqq.
Thanks for the valuable overview.. Is brain MRI/MRA mandatory for the acute treatment with tPA?
as far as the neurology service I know, if a stroke is the most likely diagnosis you do a CT scan of the head to rule out significant bleeding and push that tPA, the rest, while important information for prognosis and secondary prevention, is not relevant to that decision.
@@wolfpytlak2786 I concur with Wolf here. Not only is an MRI/MRA unnecessary for administration of tPA, it's generally inappropriate to delay tPA for one since the MRI/MRA takes much longer than a CT, and the effectiveness of tPA is critically dependent upon how quickly the patient receives it after onset of symptoms. The only time you would start with an MRI rather than a CT for a patient presenting with a possible stroke is if they are clearly outside of the tPA window (or outside the longer window for mechanical thrombectomy, if at a hospital where this can be performed).
I didn't know that brain MRI takes too long besides I thought theoretically it could be TIA (and other possible diagnoses even if were less common) and this could be overtreatment and/or lead to harm ..
Great video.Do you need to to coagulation profile before giving tpa to look for bleeding risk? OR DO YOU DO only blood sugar before tpa?
In indications for tPA, you have mentioned "or other less common features are present". What are these features?
Great video as always, doc- ever wade into the great tPA controversy / debate between our EM and neurology colleagues?
Thanks Gerald! I steer relatively clear of controversies like tPA because it rarely comes up in my personal practice. As an academic hospitalist, the decision about tPA in a patient with acute stroke is almost always made in the ED before I've even seen them. Also, the amount of relevant literature one must read through in order to be sufficiently well versed in the primary data is substantial, and there's just too many other things to read about!
Helpful sir
Bro 🆗👀
sincerely thanks ..
Thanks
Thank You Sir.
🎉🎉🎉okay so what are you doing
Now!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Bro Brother 😅
Thank u sir
❤a stroke
👌
Thanks ✳️👍✳️👍✳️👍
Sembuhkan dunia.
what the heck are u saying??? tPA is absolute contraindicated in ischemic stroke ?????????????????
then when do u give tPA
@8:00 there is a specific list of contraindications to tPA. If the patient has any of those features, then it's contraindicated. Otherwise, it is not.
@@StrongMed yes please check your list again, u have written that ischemic stroke is one of the absolute contraindications
@@ahlammohammed2135 It lists previous ischemic stroke within the past 3 months. For example, if a person had an ischemic stroke 1 month ago, and now presents with a new, entirely different stroke. Even if the new stroke is within 4.5 hrs, the fact that the person had a different stroke within that 3 month window means that they cannot receive tPA.
@@StrongMed ohh that is very interesting , now I understood ... thanks alot for the illustration!!!
Thanks
Thank you!