1. CTA is becoming the standard for acute stroke imaging, but options remain for collateral/penumbral assessment in selecting patients for endovascular reperfusion therapy 2. Non-randomized data support the target mismatch theory for patient selection for endovascular reperfusion therapy 3. NCCT remains the standard for IV tPA treatment decision making, but increased use of routine advanced imaging may ultimately provide data supporting CTP use for IV tPA decision making 4. Ability for advanced imaging to predict who will bleed after reperfusion therapy remains a challenge
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• If even considering CVA as diagnosis, call Code Stroke • Consider mechanical thrombectomy in CVA patients who may not be IV tPA patients • Role of head trauma in IV tPA exclusion criteria poorly defined • Always consider VTE in pregnant patients with leg pain • Pregnant & postpartum patients are at significantly increased risk of VTE • Diagnostic workup with Modified Well’s Criteria • Lovenox is the treatment of choice for VTE in pregnancy
•Consider atypical presentation for ACS in elderly patients •Risk factors for severity of acute pancreatitis include advanced age, obesity, organ failure, and pleural effusion •Can use APACHE II score to risk stratify in the ED •Blunt aortic injury (BAI) is a rare but often deadly entity •Consider in all cases with significant mechanism •Can have atypical/no symptoms or have distracting injury •Management of BAI includes permissive hypotension and rapid transfer to the operating room
- severe onset of symptoms - worsening clinical course
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