The first part of this series dealt with guidelines for the care of ischemic stroke. This issue applies the same principles of evidence-based medicine to hemorrhagic stroke and traumatic brain injury. Hemorrhagic stroke is less common than ischemic stroke, but can be more devastating.
While rhythm disturbance may be a common presenting complaint among adult emergency department (ED) patients, the incidence of cardiac dysrhythmia among pediatric patients is relatively low. In one retrospective review, primary cardiac arrhythmias were identified in 13.9 per 100,000 pediatric ED visits.1 The incidence of these dysrhythmias peaked during infancy and then again in adolescence.1 Cardiac dysrhythmias in children may be due to primary conduction abnormalities or may occur in the setting of structural heart disease, metabolic derangements from toxic ingestions, or infections. Supraventricular tachycardias (SVT) represent the most common pediatric dysrhythmias in adolescents (an estimated 63% of all documented tachycardias).1 After a brief review of initial emergency management of dysrhythmia, the authors will emphasize important pediatric ECG parameters and how they differ from adults.
A historical cohort study from San Francisco General Hospital evaluated patients ≥18 years old that were hospitalized and received at least one dose of ceftriaxone. In a multivariable analysis, for every day a patient also received doxycycline the rate of Clostridium difficile infection was 27% lower than for those who did not receive doxycycline (hazard ratio, 0.73%; 95% confidence interval, 0.56-0.96).
Small subcortical brain infarcts, known as lacunar strokes, account for about 25% of all ischemic strokes.
