EM Quick Hits 49 Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Skin Foreign Body Hack, CT Radiation Risk, Emergency Fund

Topics in this EM Quick Hits podcast

Anand Swaminathan on endovascular therapy for large vessel occlusion ischemic stroke (0:38)

Sarah Reid on intussusception clinical pearls and pitfalls (8:45)

Andrew Petrosoniak on 5 tips on management of stable penetrating trauma patient (15:49)

Peter Toth on slit lamp hack for skin foreign body removal (23:31)

Nour Khatib & Jonathan Wallace on CT radiation risk (27:43)

Matt Poyner on the importance of an emergency fund (34:21)



Podcast production, editing and sound design by Anton Helman

Podcast content, written summary & blog post by Alex Chan, edited by Anton Helman

Cite this podcast as: Helman, A. Swaminathan, A. Reid, S. Petrosoniak, A. Toth,, P. Khatib, N. Wallace, J. Poyner, M. EM Quick Hits 49 - Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Foreign Body Hack, Radiation Risk, Emergency Fund. June, 2023. https://emergencymedicinecases.com/em-quick-hits-june-2023/. Accessed September 16, 2025.

The eligibility criteria of endovascular therapy for large vessel strokes may be expanding in the future



* Current guidelines indicate endovascular therapy (EVT) for large vessel occlusion strokes occurring within 24 hours of presentation with neuroimaging demonstrating a small ischemic core with a viable penumbra

* The ANGEL-ASPECT and SELECT2 RCTs published in 2023 suggested that patients presenting with large infarcted cores receiving EVT were found to have superior neurologic outcomes compared to medical management alone

* In the SELECT Late retrospective study, there additionally appeared to be a benefit of neurologic outcomes for patients receiving EVT despite presenting with large vessel strokes beyond 24 hours of "last known well"

* Although the mentioned studies suggest benefit for EVT beyond our current eligibility criteria, further studies are needed before applying the evidence to clinical practices  as SELECT was a retrospective study and biases and limitations were present



Update 2024: A prospective, multicenter, open-label, randomized trial including 253 patients with acute ischemic stroke due to large vessel occlusion in anterior circulation and a large established infarct (ASPECTS score of 3-5) and NIHSS less than 26 found that endovascular thrombectomy + medical therapy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2.58, 95%CI 1.6-4.15, P=0.0001), lower mortality (hazard ratio 0.67, 95% CI 0.46-0.98, P=0.038), and increase in patients with independent neurologic outcomes mRS=90%, and may be a valuable tool to decrease ED length of stay

* Abdominal X-ray is much less sensitive, but may identify complications such as obstruction or perforation





* The management of intussusception includes:



* IV maintenance and bolus fluids to treat hypotension or shock, early analgesia

* Empiric antibiotics if perforation/peritonitis are suspected

* Consultation with Pediatric Radiology and/or Pediatric Surgery for air enema reduction under fluoroscopy or ultrasound guidance

* Laparotomy is considered if reduction is unsuccessful

* Newer data suggests it is safe and reasonable to discharge patients post reduction of intussusception if they are observed to be stable in the ED for 4 hours