Ep 208 Paradigm Shift in Ischemic Stroke Management Part 1: Disabling Strokes

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 28 October 2025

⏱️ 96 minutes

🔗️ Recording | iTunes | RSS

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Summary

We are amidst a paradigm shift in the emergency management of acute ischemic stroke. The traditional way of categorizing ischemic strokes as 'minor' vs 'major' is no longer relevant to what we do in the ED. It's now about 'disabling' vs 'non-disabling' strokes. And this is no small change. This categorization dictates urgency of ED work-up and treatments, imaging choices, treatment decisions and goals of care. In this Part 1 or our 2-part main episodes EM Cases podcast series on management of ischemic stroke with Dr. Walter Himmel and Dr. Katie Lin, we answer questions like: How can we best rapidly determine if an ischemic stroke is disabling or non-disabling at the bedside? In what ways are 'wake up strokes' managed uniquely and what's the latest thinking on their pathophysiology? How should we best prioritize imaging depending on timing, geography and resources? How do we best predict large vessel occlusion amenable to endovascular therapy (EVT) at the bedside? How can we efficiently establish goals of care at the bedside to inform our emergency decision making around strokes? Which is better for thrombolysis in ischemic stroke - Tenecteplase or Alteplase? How have contraindications to IV thrombolysis changed over the last decade? When should we consider bridge therapy with EVT after IV thrombolysis? What are 4 key items the ED physician should have ready for the stroke neurologist on the first call? and many more... If you enjoy EM Cases content please consider a donation to help support ongoing FOAMed here: https://emergencymedicinecases.com/donation/

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world. EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or, or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians.
0:24.3	First, just a quick word from our sponsor Metricade, the experts in complex physician scheduling since 2012.
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1:32.2	There's a paradigm shift in stroke management that we need to know about, and we need to know about
1:37.1	this massive change in the way we recognize and treat strokes for two reasons. One, because the
1:43.1	nuanced decisions we make in the ED will significantly impact
1:46.7	outcomes, and two, because stroke is one of the leading sources of medical legal action
1:52.1	against ED physicians. The outcomes of patients with strokes depend on the specific diagnosis,
1:59.8	the timing, and the pathway the patient is placed on.
2:03.6	We need to get this right.
2:05.9	And who better to help us understand this paradigm shift in stroke management than Katie Lynn,
2:10.4	EM physician and stroke physician at foothills in Calgary, and the new deputy director of EM cases?
	...

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