Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.

An increased emphasis on stroke care has led to a proliferation of specialized stroke teams despite relatively few trials demonstrating their efficacy. Our academic stroke center incorporated a unique setup allowing for the comparison between stroke teams and emergency physicians. During weekday working hours, a stroke team would respond to the emergency department for stroke activations. During all other times, the emergency physician caring for the patient would make all treatment decisions. We sought to determine whether there was any difference in treatment and outcomes between these two groups. We conducted a retrospective review of all stroke activations from January 2015 to June 2016 and compared the thrombolytic administration rates, modified Rankin Scale (mRS) at discharge, and change in National Institutes of Health Stroke Scale (NIHSS). A total of 415 stroke activations were identified. Of those, 69 of 262 patients (26.3%) seen by emergency physicians and 60 of 153 patients (39.2%) seen by neurologists received thrombolysis (P = 0.006). No significant difference was found in the discharge mRS or change in NIHSS between the two groups. Emergency physicians administered significantly less thrombolytics than did neurologists. No significant difference was observed in outcomes, including mRS and admission-to-discharge change in NIHSS.

Bilateral Retinal Detachment in a Pediatric Patient.

BACKGROUND: Pediatric retinal detachments occur rarely, and thus may be easily missed. Without treatment, this condition leads to permanent vision loss. Patients with Stickler syndrome, an inherited disorder of collagen synthesis, are more likely to have retinal detachments than the general population. CASE REPORT: We present a case of a 9-year-old boy who presented to the Emergency Department with blurry vision, and who was subsequently diagnosed with bilateral retinal detachments. The patient underwent successful operative intervention. He was eventually determined to have Stickler syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for emergency physicians to recognize pediatric visual problems such as retinal detachment, as their presentations may be unusual, and delay of definitive care could result in lifelong visual impairment.

Lymphangitis From Scolopendra heros Envenomation: The Texas Redheaded Centipede.

Envenomation by Scolopendra heros, the Texas redheaded centipede, can present variably. Although transient pain and erythema are often treated conservatively, complications may include cellulitis, necrosis, myocardial infarction, and rhabdomyolysis. We present a case of an elderly man who came to the emergency department with lymphangitis and dermatitis secondary to a centipede sting that awoke him from sleep. It is important to recognize the potential of centipede envenomation to have severe local and systemic manifestations.