It's a double header of stroke treatment and controversy. Anand Swaminathan from EM Lyceum and Ryan Radecki from EM Literature of Note help tease out:

How do you manage blood pressure in acute ischemic stroke?

Should you give thrombolytics up to 4.5 hours after symptom onset?

When do you decide that a CVA is actually a TIA?

What is the age cutoff for using thrombolytics in acute ischemic CVA?

And... What's up with the new American College of Emergency Physicians clinical policy on TPA in stroke?

Articles and clinical policies discussed in this podcast

ERCast episode three: Discussion and debate with a stroke neurologist on thrombolytics beyond the 3 hr window

BMJ: Why we can't trust clinical guidelines

ACEP Clinical Policy on Use of IV TPA for Acute Ischemic Stroke

Stroke trials discussed in this podcast

Original NINDS trial from NEJM 1995

Original ECASS trial from NEJM 1995

ATLANTIS trial from 2002

ECASS III

IST-3

Products mentioned

MED SKETCH: Anatomy Drawing App