Stroke FM

Stroke FM

By Stroke FMMedicineHealth & Fitness
Download on the App Store

Stroke FM episodes

  • 08 Blood in the Brain is Bad (BBB)

    Key Terms: ICH, blood pressure control, spot sign

    Hosts: Phavalan Rajendram, Neha Patel, Houman Khosravani

    Summary:

    • Hemorrhagic strokes (HS) account for ~15-20% of all strokes
    • There is a significant morbidity and mortality associated with HS
    • Early blood pressure control is key in the management of HS
    • CTA can identify a spot sign (may indicate increased risk of hematoma expansion)
    • Etiologies
    • Find out if the patient is on anticoagulation so that it can be reversed
    • Make sure the patient is stable before CT scan (may need anti-emetics, intubation, etc.)
    • Early blood pressure control is key
    • Blood pressure target < 140/90
      • See ATACH-2 and INTERACT trials on BP control in ICH
      • Consult NSx early as surgical options may be available
        • See STICH-2 trial on surgical management of superficial ICH without IVH
        • Prognostication can be aided with “ICH Score”
          • 31 min
        • 07 What-Up DAPT!?!

          Key terms: DAPT, Minor stroke, TIA

          Hosts: Tess Fitzpatrick, Katherine Sawicka, and Houman Khosravani

          Summary:

          • Monotherapy with antiplatelet
          • Dual antiplatelet evidence critical appraisal
          • CHANCE
          • POINT
            • 32 min
          • 06 Would you like fries with that? Giving Feedback

            Key terms: Feedback, communication, competence by design

            Hosts: Neha Patel, Phavalan Rajendram and Houman Khosravani

            Summary:

            • Feedback can feel uncomfortable
            • More feedback at more time points is effective for resident growth
              • Competence by design
              • Types of feedback
              • Debriefing as a team after difficult and complex medical situations
              • How to learn and grow from feedback as a resident
              • Sandwich approach to feedback
              • Be constructive, goal is to help person improve ultimately
                • 14 min
              • 05 Stayin' Alive (ah, ah, ah)

                Key terms: Stroke rotation survival guide, NIHSS tips, Burnout prevention

                Hosts: Katherine Sawicka, Tess Fitzpatrick, and Houman Khosravani

                Summary:

                • Code stroke basics

                  • Establish roles within the team – history-taker, examiner

                  Clarify history from EMS, family, bystanders (ie: last seen well)

                  Know your NIHSS
                • Anxiolysis

                  • Useful apps

                  NIHSS score & stroke tools

                  Neuro toolkit

                  Do some reading ahead of time

                  Canadian Best Practices guidelines are a great resource

                  Learn ASPECTS
                • Prevent burn-out
                  • 36 min
                • 04 Pipe Cleaners

                  Key Terms: Endovascular therapy (EVT), Mechanical Thrombectomy, Large Vessel Occlusion, CT-Perfusion, Perfusion Mismatch

                  Hosts: Ryan Muir, Tess Fitzpatrick, Houman Khosravani

                  Summary:

                  • What is endovascular therapy?
                  • What were the early trials of EVT – what did we learn from them?
                    • MULTI – MERCI
                    • PENUMBRA PIVOTAL
                    • IMS-III
                    • MR. RESCUE
                    • Modified Rankin Scale (MRS) at 90 days).
                    • These trials were summarized in a meta-analysis performed by the HERMES in collaboration in 2016.
                      • MR. CLEAN
                      • ESCAPE
                      • REVASCAT
                      • SWIFT PRIME
                      • EXTEND IA
                      • In the HERMES pooled analysis the number needed to treat with EVT was 2.6 persons to reduce MRS by 1 point.
                      • One trial was done later also favoured EVT, but was not included in the HERMES meta-analysis - the THRACE trial


                        • DAWN
                        • DEFUSE 3
                        • As a result of DAWN and DEFUSE 3, the 2019 AHA/ASA Guidelines now suggest:
                          • Within 0 – 6 hours of symptom onset: Direct aspiration thrombectomy as a first pass or mechanical thrombectomy with a stent retriever should be done if the following criteria are met: (i) prestroke MRS of 0 – 1 (ii) causative occlusion of the internal carotid artery or MCA segment 1 (M1) (iii) age >18 years (4) NIHSS ≥ 6
                          • Within 6 – 24 hours of symptom onset
                          • In selected patients with acute ischemic stroke within 6 – 16 hours of last known normal who have a large vessel occlusion in the anterior circulation and meet other DAWN or DEFUSE 3 eligibility criteria, mechanical thrombectomy is recommended
                          • In selected patients with acute ischemic stroke within 6 – 24 hours of last known normal who have a large vessel occlusion in the anterior circulation and meet other DAWN eligibility criteria, mechanical thrombectomy is reasonable
                            • 33 min
                          • 03 Dran(o)

                            Key terms: thrombolysis, door-to-needle, contraindications

                            Hosts: Neha Patel, Phavalan Rajendram, & Katherine Sawicka

                            Summary:

                            • What is tPA?
                            • Indications for tPA
                            • Does time matter?

                              • NINDS

                              ECAS III
                            • TNK

                              • TEMPO2
                            • Contraindications for tPA
                            • tPA and EVT

                              • SWIFT DIRECT
                            • Door-to-needle time tips
                            • Post tPA care
                              • 21 min
                            • 02 Mechanics at a Stroke Code

                              Key Terms: Code stroke, protocol, intravenous tPA risks, intravenous tPA contraindications, ASPECTS and stroke mimics

                              Hosts: Ryan Muir, Tess Fitzpatrick, Houman Khosravani

                              Summary:

                              In this episode the hosts discuss the approach to the acute assessment of a patient presenting as a code stroke. This episode also reviews the indications, relative contraindications and absolute contraindications to thrombolysis.

                              • Defining roles within the Code Stroke Team: splitting the team into MD1 and MD2.
                              • Assess patient stability. Airway, Breathing, Circulation, Glucose. Ask yourself is this the type of patient who needs intubation or ICU? Is this the type of patient you may need help from the ER doctor managing vitals?
                              • Examination and NIHSS performed by MD1 while MD2 is collecting collateral information (don’t delay the scan for the full NIHSS, this can be completed later).
                              • Before travelling to the scanner, be prepared: thrombolysis kit and anti-hypertensives
                              • Be on the lookout for “STROKE MIMICS.” Some common stroke mimics are depicted below in the Table 1 Adapted from the 2017 American Academy of Neurology Continuum Article titled, “Clinical Evaluation of the Patient with Acute Stroke.”
                              • ASPECTS score
                              • MD2 to review indications and contraindications to thrombolysis and endovascular therapy
                              • Risks of thrombolysis: hemorrhage, angioedema
                              • Documenting the discussion of consent for thrombolysis and endovascular therapy
                                • 33 min
                              • 01 Stroke.FM Intro

                                Introducing Stroke.FM!

                                This Stroke focused podcast is developed by faculty and residents who are in The University of Toronto Neurology Program. It is geared towards residents and medical students with a keen interest in Stroke and Stroke related topics. This podcast is hosted by Toronto Stroke Neurologist Dr. Houman Khosravani and is regularly frequented by residents in the program including Phavalan Rajendram, Ryan Muir, Katherine Sawicka, Tess Fitzpatrick, Neha Patel, Sydney Lee, and Jaime Cazes. Check us out on stroke.fm

                                1 min

                              About Stroke FM

                              From the publisher's feed

                              You've heard of thrombolysis? We are here to deliver anxiolysis when it comes to learning about stroke. We are a Stroke Educational podcast originally developed by a keen group of doctors in the…