Nervous System + HEENT (May 2018)
AIR CAPSULE: HEENT
Articles:
Edlow, J. Managing Patients With Transient Ischemic Attack. Annals of Emergency Medicine 2018. aromatherapy vs. zofran
Questions:
For a Review Article
- How has reading the article changed your practice?
- What information had you believed in previously that were debunked by reading this article?
- What new information did you learn from reading this article?
- What are current areas of uncertainty on this topic that can be potential areas for research?
For an Original Research Article
- What are some strengths of the study?
- What are the limitations?
- What are the main outcomes of the study?
- Does reading this article change your practice? If so, how?
5 comments
April et al.
Similar to our TXA for epistaxis article last month, another relatively benign intervention (smelling isopropyl alcohol) worth trying before more invasive interventions.
.
I was on vacation and my tour group all got some viral gastroenteritis, on a FOOD and WINE tour! I suggested this treatment, but couldn’t find the isopropyl alcohol pads anywhere.
Edlow
.
A nice succinct review of TIA management. Remember, it’s really an opportunity to prevent devastating stroke and should be taken seriously even if they come to you after their sx resolved. “rapid implementation of multiple interventions – can potentially reduce outcome of stroke by up to 80%”.
.
I also didn’t know that “involuntary movements are typical of limb-shaking TIA, due to high grade ICA stenosis”.
Edlow: Managing TIA article
* How has reading the article changed your practice?
* This article has allowed me to appreciate that TIA is a life threatening diagnosis with patients needing evaluation and treatment almost as urgently as those presenting with stroke. Going forward I will treat TIA pts as “Code TIA” patients.
* What information had you believed in previously that were debunked by reading this article?
* All pt’s with suspected TIA need admission, however this is not true. Pt who are reliable and safe can be sent home if they can get TIA work up/follow up with neuro within 24hrs
* Pt with episodic dizziness aren’t likely experiencing a TIA.
* What new information did you learn from reading this article?
* ABCD2 score is not a tool to determine which pt safe to be dced home.
* Afib accounts for about 1/4 of TIAs
* What are current areas of uncertainty on this topic that can be potential areas for research?
* What types of outcomes do pt suspected of TIA (w/t neg CTA who have been started on secondary prevention strategies) have when they are sent home
April et al.
How has this article changed your practice?
I think this is a great idea but I think that several of your patient’s might roll their eyes at you at the suggestion that they start huffing isopropyl alcohol.
I wonder if this would help in our emerging cohort of people who recurrently present with cyclical vomiting. This would be a more efficient strategy than snowing them when they come through the door with haldol.
New research into the MOA is obviously needed to assess how effective this intervention may actually be.
Edlow article:
I don’t know how much this review will change my day to day practice. Yes people should take an anti-platelet agent when they likely had a stroke. Not much new here.
The ABCD2 score was never going to capture everyone at risk for stroke. I have never found it very helpful. It basically says: if you’re old and may have had a TIA, you should probably stay in the hospital overnight and take some aspirin. If you’re younger maybe you can go home but you should still take aspirin. No wonder we don’t use it anymore.