Emergency Medicine Cases Ep 208 Paradigm Shift in Ischemic Stroke Management Part 1: Disabling Strokes
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Oct 28, 2025 Dr. Katie Lin, an emergency and stroke physician from Calgary, joins Dr. Walter Himmel, an experienced emergency physician from North York General, to explore recent shifts in ischemic stroke management. They discuss the crucial distinction between disabling and non-disabling strokes, which impacts urgent medical responses. Key insights include how to accurately assess disabling deficits at the bedside, strategies for managing 'wake-up strokes,' and evolving guidelines for thrombolysis and EVT therapies. This conversation highlights practical approaches for emergency care and patient-centered decision-making.
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Disabling Versus Non‑Disabling Paradigm Shift
- Replace 'minor vs major' with 'disabling vs non-disabling' to center patient impact on decisions.
- This shift changes imaging urgency, treatments, and goals-of-care conversations.
Judge Disability By Functional Impact
- Ask whether symptoms will prevent independent living or meaningfully reduce quality of life before treating.
- Prioritize speech, motor, vision, and level-of-consciousness deficits when judging disability.
Use Patient Values To Guide Treatment
- Ask patients or surrogates how symptoms affect work, walking, and meaningful activities before deciding on treatment.
- If uncertain and within window, favor treatments that preserve options later.