Large Vessel Occlusion Stroke (LVOS) is  an indication for activating stroke team. IR will be on board and this is level IA recommendation from 2015 AHA/ASA Guideline. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) extracted from NIHSS. LVOS were defined by total occlusions involving the intracranial ICA, MCA-M1, MCA-2, or basilar arteries. FAST-ED scoring system is based on NIHSS and has reliable accuracy to predict LVOS. FAST-ED will help to activate your stroke team from field and EMS will give you a score to determine this patient needs IR involvement as well as stroke team at bedside.

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British Thoracic Society/Intensive Care Society published a guideline regarding ventilatory management of acute hypercapnic respiratory failure(AHRF). I believe there are good recommendations for junior residents who do not know to deal with NIV machine and also setting initial parameter. This is augment our practice that how to approach COPD patient in ED with NIV.

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Trimethoprim–Sulfamethoxazole or Placebo for skin Abscess

When we reviewed 3 previous studies here, here and here. We mentioned that should we really treat simple Skin abscess? NEJM published “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess” in March 2016. Patients were randomised to TMP-SMZ 320-1600 mg twice a day for 7 days versus Placebo in patients greater than 12 years old with uncomplicated skin abscess.

Conclusion: In settings in which MRSA was prevalent, trimethoprim–sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo.

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Headache Treatment!

Expert panel from American Headache Society Published a guideline! to manage Migraine Headache in ED in Headache June 2016. They searched and found 68 randomized controlled trials. I am very happy to see our routine practice to treat headache in ED, now after years is coming to Neurology Guideline!

Metoclopramide and prochlorperazine offered as level B, and they offered Dexamethasone as Level B to prevent recurrence of Headache!


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