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Organizations’ Official Statements/Guidelines on IV tPA Use: What Do They Suggest is the Emergency Medicine Standard of Care?. 2006 Advanced Emergency & Acute Care Medicine and Technology Conference. Emergency Medicine Associates Atlantic City, NJ September 26-27, 2006.
Minimal dysarthria and slight dominant right
Chairman of Plastic Surgery
Hx: Hypertention, smoker
FH: CAD and CVA
No evidence trauma or toxicity
ECG NSR without evidence of AMI or
tPA may be efficacious therapy when used incorporating the guidelines established by the NINDS Trial
Commitment of hospital administration, neurology, neurosurgery, ED, radiology and laboratory to ensure the systems necessary for safe use
Society of Academic Emergency Medicine 2003
Insufficient Data for SOC, Barriers, Research
Canadian Assoc of Emergency Physicians 2001
CT Interpretations, Cleveland, Time to Rx
American Academy of Emergency Medicine
Not SOC-Selection Bias
NINDS Reanalysis, subanalysis
Additional Prospective Data
Data Registry Reports
Compare the results with a conventional training protocol. Most people do at least two exercises per muscle group, perform three sets and perhaps 12 or 15 reps per set. Allowing just five seconds per rep, that makes for at least 36 minutes of exercise per workout.
This is usually done three times per week. So in six weeks, a conventional program would involve 648 minutes of exercise. That's 42 times more than the subjects in our study. Are your results in the last six weeks 42 times better than theirs? I doubt it.
Remember, these golfers were exercising in a way that did not involve stretching or moving the weight over a full range of motion. So how did this affect a full range of motion activity like a golf drive?
Every one of them showed an improvement. The increase in drive distance varied from 5 to 31 yards. Keep in mind that these subjects had been golfing for up to 40 years and had handicaps as low as eleven. So getting any improvement in golfers who already play at this level is impressive. Getting it with 14 minutes of exercise spread over six weeks is truly revolutionary.
The fact is every sport -- even a finesse sport like golf -- is improved by an increase in strength. Muscles are responsible for all movement in the body and stronger muscles deliver more power to every aspect of movement, irrespective of its range of motion.
Since this study, I've gone on to improve this method of training. Further research showed that static hold times could be reduced to even less than what the golfers used. Workouts can be spaced further apart as a trainee gets stronger. I work with advanced trainees who train once every six weeks, yet they gain strength on every exercise each time they work out. The weights they hoist are enormous.
I believe the time is coming when most people will have a better understanding of the role of proper, efficient strength training methods and frequency. For the guy who wants maximum results with minimum time invested, an ultra-brief but ultra-intense workout will be performed about as often as he gets a haircut. Anything more is just lifting weights as a busy work hobby.
Education and Training
Stroke Center Certification
Designated Stroke Teams/Systems
Use of Clinical Pathways/Protocols
Training Dedicated Stroke Nurses
Time to CT and Interpretation
Use of Aspirin
Prevention Recurring Stroke
Migraine or temporal arteritis
Akinetic seizure or partial lobe epilepsy
CNS space-occupying lesions
ENT, ophthomologic pathology
tPA should be considered for appropriate patients when the NINDS criteria for safe use can be achieved
Patients and families should know the risks/benefits of tPA before it is given
Careful documentation of the medical record in necessary for every case
3/12/2014 11:27 AM