Explore the complexities of diagnosing posterior circulatory strokes that can mimic benign vertigo, and the promising potential of bedside scoring systems. Discover insights on improving survival rates through targeted pre-hospital resuscitative thoracotomy in traumatic cardiac arrest cases. Delve into the risks associated with IV contrast and its impact on acute kidney injury, highlighting the need for careful patient care in emergency settings. Each topic opens up discussions on practical applications in clinical practice.
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insights INSIGHT
Stroke Mimicry
Posterior circulatory strokes can mimic benign vertigo, making diagnosis challenging.
Bedside tests like HINTS, TriAGe+, and ABCD2 aim to differentiate strokes from benign issues.
volunteer_activism ADVICE
Bedside Stroke Tests
Evaluate HINTS, TriAGe+, and ABCD2 scores for stroke prediction in acute vertigo patients.
Consider a bedside test to rule in or out stroke before resorting to MRI.
insights INSIGHT
HINTS Exam Skepticism
HINTS exam's 100% sensitivity raises skepticism, especially given inappropriate usage in 75% of study cases.
Applying HINTS inappropriately, even by trained professionals, can lead to misdiagnosis.
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First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at the use of three bedside scoring systems; HINTS, TriAGe+ and ABCD2 scores in ED for patients presenting with possible posterior circulatory strokes. How accurate are they and can we reliably incorporate into our practice?
Next up is traumatic cardiac arrest. This has obviously got a very high mortality rate. One of the interventions that might improve mortality (for some mechanisms and patients) is a resuscitative thoracotomy, however this is a really significant intervention and we want to ensure we are targeting it at the patients that may benefit. A great paper has just been published from London Air Ambulance which might just help us to identify those patients who would benefit with more certainty, along with those where futility has already been reached.
Finally we take a look at acute kidney injury (AKI) and its association contrasted scans. Contrast induced nephropathy (CIN) has historically been a concern, particularly for patients with chronic kidney disease, with contrast causing direct injury and limited blood flow. But recent studies have questioned the actual risk of CIN & there’s been a more recent RCEM statement on the topic, but we thought this might be a nice opportunity to refresh and look at a recent paper on the topic.
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
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