Stroke
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 21 August 2016
⏱️ 9 minutes
🧾️ Download transcript
Summary
Get your attending!
Step 1: Obtain Last Known Well
* Stroke treatments including tPA and thrombectomy both require last known well* <3-4.5 hours for tPA* <24 hours mechanical thrombectomy
Step 2: Finger Stick Blood Glucose
* Hypoglycemia is classic mimic of CVA* Results can be obtained immediately
Step 3: STAT Head CT Without Contrast
* Poor sensitivity for ischemic stroke* Primary use is identification of hemorrhagic stroke* Required prior to administration of tPA!
Step 4: Perform NIHSS
* Use calculator (MDCalc)
Step 5: Give tPA (If No Contraindications)
* Follow department protocol and contraindications* Frequently being updated
Additional Reading
* tPA Basics (EM Clerkship)* 2013 AHA Stroke Guidelines (AHA)* NIH Stroke Scale/Score (MDCalc)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
| 0:11.9 | time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a |
| 0:20.4 | secure, hippocompliant scribe that anybody can use. |
| 0:24.7 | Focus your energy on what matters, providing good patient care. |
| 0:29.5 | Use coupon code EM50 to save 50% the first month you try it, |
| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.a.i. Hello, med students. My name is Zach Olson. Thank you for downloading this |
| 0:49.9 | episode of the EM Clerkship Podcast. I want you to close your eyes and imagine. You're halfway |
| 0:58.0 | through your shift. Department's really busy. You've had a few chest pain patients, a nausea, |
| 1:03.3 | vomiting, a seizure, nothing too crazy so far. When you overhear a call on the radio about an |
| 1:10.0 | incoming stroke. |
| 1:11.6 | University Hospital's Amulance 48 coming to ALS with a stroke alert. |
| 1:17.6 | We have a 55-year-old female found on the floor by family. |
| 1:21.6 | She is ulcered. |
| 1:23.6 | She is positive for Cincinnati stroke scale. |
| 1:26.6 | Last known normal was 1430 hours, 1430 hours. Currently vital signs, 200 over 110. Pulse of 88 any regular. She is cold and clammy. It's on unknown meds for hypertension. We're approximately seven minutes out. |
| 1:44.0 | What is your approach? |
| 1:52.0 | The most important thing to remember about stroke, time is brain. |
| 1:57.0 | The American Stroke Association guidelines really emphasize this, and hospitals are now judged |
| 2:03.3 | by this whole list of time-based cutoffs that they have to hit, just like we had to do with |
| 2:08.5 | stemmy, because time is brain. Here's what this means. If you ever have a patient that looks like a |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.