Volume 16, Issue 7, December 2015.
Bryan Darger, BA, et al.
Introduction: The purpose of this study was to assess safety and efficacy of thrombolysis in the
setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP
control prior to thrombolysis.
Methods: We performed a retrospective review of patients treated with tissue plasminogen activator
(tPA) for acute ischemic stroke (AIS) between 2004-2011. We compared the outcomes of patients
treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring
standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined
by all grades of hemorrhagic transformation and neurologic deterioration. The secondary outcome
was efficacy, determined by functional status at discharge, and in-hospital deaths.
Results: Of 427 patients included in the analysis, 89 received aggressive BP control prior to
thrombolysis, 65 received standard BP control, and 273 required no BP control prior to thrombolysis.
Patients requiring BP control had more severe strokes, with median arrival National Institutes of
Health Stroke Scale of 10 (IQR [6-17]) in patients not requiring BP control versus 11 (IQR [5-16]) and
13 (IQR [7-20]) in patients requiring standard and aggressive BP lowering therapies, respectively
(p=0.048). In a multiple logistic regression model adjusting for baseline differences, there were no
statistically significant differences in adverse events between the three groups (P>0.10).
Conclusion: We observed no association between BP control and adverse outcomes in ischemic
stroke patients undergoing thrombolysis. However, additional study is necessary to confirm or refute
the safety of aggressive BP control prior to thrombolysis.
Volume 16, Issue 6, November 2015.
Jessica N. Schmidt, MD, MPH, et al.
Introduction: Quality resident education in point-of-care ultrasound (POC US) is becoming
increasingly important in emergency medicine (EM); however, the best methods to evaluate
competency in graduating residents has not been established. We sought to design and implement
a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating
residents at our institution.
Methods: We evaluated nine senior residents in both image acquisition and image interpretation for
five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram
(ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam
(OSCE) directed assessment with a standardized patient model. Image interpretation was measured
with a multiple-choice exam including normal and pathologic images.
Results: Residents performed well on image acquisition for core skills with an average score of
85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta).
Residents scored well but slightly lower on image interpretation with an average score of 76%.
Conclusion: Senior residents performed well on core POC US skills as evaluated with a rigorous
assessment tool. This tool may be developed further for other EM programs to use for graduating
resident evaluation.
