acute stroke patient
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2021 ◽  
pp. 229255032110270
Author(s):  
Ashley N. Boustany ◽  
Carly D. Comer ◽  
Harsha Gopal ◽  
Samuel J. Lin ◽  
Sumner A. Slavin

Diplopia after rhinoplasty is a rare complication that requires immediate medical attention. Workup should include a complete history and physical examination, appropriate imaging, and consultation with ophthalmology. Diagnosis may be challenging due to the wide differential ranging from dry eyes to orbital emphysema to an acute stroke. Patient evaluation should be expedient, though thorough to facilitate time-sensitive therapeutic interventions. Here, we present a case of transient binocular diplopia presenting 2 days after closed septorhinoplasty. The visual symptoms were attributed to either intra-orbital emphysema or a decompensated exophoria. This is the second documented case of orbital emphysema after rhinoplasty presenting with diplopia. It is the only case with a delayed presentation as well as the only case that resolved after positional maneuvers.


Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2263-2267 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel ◽  
Andrew M. Southerland ◽  
Charles Wira ◽  
Sepideh Amin-Hanjani ◽  
...  

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has broad implications on stroke patient triage. Emergency medical services providers have to ensure timely transfer of patients while minimizing the risk of infectious exposure for themselves, their co-workers, and other patients. This statement paper provides a conceptual framework for acute stroke patient triage and transfer during the COVID-19 pandemic and similar healthcare emergencies in the future.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dot Bluma ◽  
Nicole Bennett ◽  
Jessica Link

Background and Purpose: EMS pre-notification of a suspected acute stroke patient assists the hospital in mobilizing the appropriate personnel and resources before the patient arrives. The pre-notification by EMS and mobilization of the hospitals stroke team will increase the probability of the appropriately screened acute stroke patient receiving thrombolytic therapy. The Wisconsin Coverdell Stroke Program (Coverdell) performed a multi-quarter analysis of the successes and barriers hospitals were experiencing with EMS pre-notifying, with an overarching goal to increase this percentage to >80%. Methods: Coverdell’s 66 participating hospitals represent 78% of annual stroke admissions to Wisconsin hospitals. Coverdell hospitals participate in the quarterly Coverdell Learning Collaborative (CLC) where they review several aggregated data points. Of these, EMS pre-notification times are analyzed and discussed. Stroke Coordinators at hospitals’ performing at a high level shared with the CLC their performance improvement activities and best practices related to EMS pre-notification. Methods used consisted of, educating and training EMS caregivers on improving pre-arrival notification by communicating in plain language stroke symptoms or verbalizing a “possible stroke”; educating and training emergency department caregivers on where to document the EMS pre-arrival report in the EHR; and educating the stroke data abstractor on where the EMS pre-hospital report is located in the EHR. Findings: In analyzing quarterly data from Q1 2017 to Q1 2019, our multi-disciplinary approach demonstrates impressive results. EMS pre-notification rose from 68.1% to 77.0%, with 82% reached in Q2 2018. Associated with this the median DTN time for those arriving by EMS decreased from 49 to 44 minutes, with the lowest median time in Q2 2018 of 42.5 minutes. Furthermore, thrombectomy therapy (alteplase and mechanical thrombectomy) administration rates increased from 21.5% to the highest in Q2 2018 at 26.8%. Conclusion: A multi-faceted approach focused on improving communication between EMS and hospitals by pre-notifying of a suspected stroke patients arrival, has led to remarkable improvements in Coverdell’s outcome data.


2019 ◽  
Vol 132 ◽  
pp. 245-250
Author(s):  
Hui Li ◽  
Jian-Feng Liu ◽  
Cong-Hui Li ◽  
Ji-Wei Wang ◽  
Yang-Yang Tian

2018 ◽  
Vol 37 (4) ◽  
pp. 233-236 ◽  
Author(s):  
Hillary Logue ◽  
Randi Collinson ◽  
Mougnyan Cox ◽  
Riti Kanesa-Thasan ◽  
Kofi-Buaku Atsina ◽  
...  

2018 ◽  
Vol 39 (01) ◽  
pp. 003-014 ◽  
Author(s):  
Joseph Murray ◽  
Jessica Pisegna

AbstractThis article aims to review the use of laryngoscopy to assess swallowing function in the stroke population. Since its inception in 1988, fiberoptic endoscopic evaluation of swallowing (FEES) has become an established procedure with distinct objective findings and practical applications, enabling many to choose it as the primary instrumental tool in evaluating poststroke dysphagia. In this article, we outline the decision-making process of when to use FEES. We highlight considerations for the acute stroke patient and visual signs that guide decision making during a FEES, such as secretions, swallowing frequency, and pharyngeal squeeze elicitation. The application of the ice chip protocol for stroke patients who have been nil per os is discussed, along with common observable events on FEES performed on stroke patients like a delay, penetration/aspiration, and bolus retention. Finally, we briefly review testing interventions and follow-up readiness with FEES.


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