Acute Ischemic Stroke and Transient Ischemic Attack
Endovascular Devices in the Treatment of Stroke
Lauren M. Nentwich, MD
Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
Endovascular treatment of acute ischemic stroke (AIS) enables access to occluded intracranial vessels for local administration of thrombolytics, mechanical embolectomy, and/or angioplasty. There are currently four mechanical devices cleared by the Food and Drug Administration (FDA) for recanalization of arterial occlusion in patients with AIS; however, despite being cleared by the FDA, none of these devices have an FDA clinical indication due to the need for randomized comparison with medical therapy devices. Endovascular interventions are extremely time dependent, and reduced time from symptom onset to reperfusion is highly correlated with better clinical outcomes.
Syncope
Annalee M. Baker, MD
Ronald O. Perelman Department of Medicine, NYU Langone Medical Center, Bellevue Hospital, New York, NY
Although relatively insensitive in isolation, the electrocardiogram (ECG) is a low-cost and noninvasive test that, when abnormal, confers a higher risk of adverse events and death. The ECG is the only bedside test that is indicated as a level A recommendation by the American College of Emergency Physicians (ACEP) in all syncope patients. In addition to identifying any tachy- or bradyarrhythmias, other potentially significant patterns that should be identified include evidence of ischemia, atrioventricular block, prolonged or shortened corrected QT interval, Wolff-Parkinson-White preexcitation pattern, hypertrophy and/or bundle branch blocks, and Brugada pattern.
Anatomic relationship of the esophagus to the trachea and heart.
Diseases of the Stomach
Esophageal Foreign Bodies: Button Batteries
Tara C. Sheets, MD, FACEP
Baylor College of Medicine, Section of Emergency Medicine, Department of Medicine
Moath Amro, MD
Baylor College of Medicine, Section of Emergency Medicine, Department of Medicine
A button battery in the esophagus is a true emergency due to the extremely rapid action of the alkaline substance on the mucosa. Burns to the esophagus have been reported within 4 hours of ingestion, with perforation within 6 hours. If the button battery is lodged in the esophagus, then emergent endoscopy should be performed for removal. If the button battery has passed the esophagus, then it need not be retrieved from an asymptomatic patient unless it does not pass through the pylorus after 48 hours of observation; endoscopic retrieval is the preferred treatment. Any patient with signs and symptoms of gastrointestinal tract injury requires immediate surgical consultation.
As seen in Scientific AmericanTM Emergency Medicine.
