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Study objectives: We determine whether standard ECG intervals, based largely on population data from middle-aged men, are applicable to the elderly, particularly those older than 90 years. Methods: The medical records of all patients aged 90 years and older presenting to our institution for health maintenance examinations in 2002 were examined. Data on rhythm, QTc, QRS, and PR intervals was collected. The presence of coronary artery disease, including history of myocardial infarction, valvulopathy, or presence of pacemaker, was also recorded. A prolonged QTc interval was defined as 440 ms or greater. A prolonged QRS interval was defined as 100 ms or greater. A prolonged PR interval was defined as 200 ms or greater. All patients in the mentioned cohort were captured; there were no missing records. Results: Of the 60 total patients, 35 had an ECG performed as part of their routine medical examination. Fourteen of the 35 patients had a history of coronary artery disease (CAD) as defined above, whereas 21 patients had no such history. The mean PR, QRS, and QTc intervals are summarized in Table 1. The presence of pronged intervals is summarized in Table 2 according to intervals defined in the methods. Conclusion: ECG intervals are prolonged in approximately one third of all patients older than 90 years who present for routine medical care. The presence of coronary artery disease does not appear to have much impact on the ECG intervals. However, mean and median values for the PR, QRS, and QTc intervals do not differ greatly from published normals. Table 1, abstract 230 . Mean Rate (SD; Range) Mean PR Interval, ms (SD; Range) Mean QRS Interval, ms (SD; Range) Mean QTc Interval, ms (SD; Range) Whole group 70 (11.85; 41–102) 199 (36; 148–282) 105 (28.6; 76–190) 436 (29.54; 385–505) CAD group 63 (10.29; 41–78) 207 (39; 124–282) 102 (22.8; 76–190) 429 (27.86; 385–503) Non-CAD group 68 (8.80; 53–103) 196 (35; 148–280) 112 (31.1; 76–102) 438 (31.32; 397–505) Table 2, abstract 230 . Frequency of Prolonged PR Interval Frequency of Prolonged QRS Interval Frequency of Prolonged QTc Interval Whole group 15 (43%) 14 (40%) 10 (29%) CAD group 4 (29%) 6 (43%) 3 (21%) Non-CAD group 11 (52%) 8 (38%) 7 (33%) more...

u t t b 45-year-old woman had a syncopal episode while reparing for some appointments. The episode was decribed as a gentle “easing down”; the patient’s husband aught her before she hit anything. She did not have any ead trauma. The past medical history was notable for ecently diagnosed carcinoma of the head of the panreas, for which she underwent biliary stent placement at nother instititution a few days before the syncopal episode. Physical examination revealed an extremely tiredppearing woman who was able to answer some quesions but had an altered level of consciousness. Her vital igns were within normal limits except for temperature, hich was 35.8°C. Extremities demonstrated pitting dema up to the knees. The rest of the physical examiation findings were normal. An electrocardiogram (EKG) was obtained immeditely and showed markedly peaked T waves, with a new eft bundle branch block (Figure 1). Because markedly levated T waves are consistent with hyperkalemia, elecrolyte levels were determined immediately and, simulaneously, treatment for hyperkalemia was instituted. he patient received 1 ampule of 10% calcium chloride nd 10 units of regular insulin intravenously, followed by ampule of D50 and 1 nebulizer treatment of 2.5 mg of lbuterol. After these measures, EKG was repeated and howed normalization of the T waves and disappearance f the left bundle branch block (Figure 2). The serum otassium level was 7.3 mEq/L. Arterial blood gas analysis revealed the following: pH .46; PCO2, 27 mm Hg; and bicarbonate, 16 mEq/L. The more...

Design/Methods: Adult patients presenting to the emergency department who had an ultimate discharge diagnosis of ischemic stroke were included in this cohort. The prehospital GCS was obtained from ambulance records in real time, performed by EMS crew. The outcomes of interest were stroke severity as measured by NIHSS, occurrence of endovascular intervention, functional outcome measured by modified Rankin score, and death within 90 days. Logistic regression analyses using JMP 8.0 for the mac performed to assess for correlation. Results: There were upto 4 pre-hospital GCS collected in the cohort (n=145), depending on transportation times. For this study, the first pre-hospital GCS, obtained at the time of first patient contact, was used. GCS Distribution followed a non parametric pattern; the median GCS was 15, range 3-15, IQR 12.5-15. The median and IQRs were: pulse 78 (70-90), sBP 151 (133-176), dBP 83 (72-97), MAP 106 (95-121). Table 1 depicts the number of patients with each GCS, and their median time of arrival to the ED after symptom onset. On univariate analysis, prehospital GCS was significantly correlated with each of the outcome measures of interest. Patients with lower GCS were significantly more likely to have more severe strokes (P Conclusions: The prehospital GCS appears to be a good predictor of stroke severity, and thus correlates for higher likelihood of endovascular intervention. Similarly, the prehospital GCS also correlates well with functional outcome at hospital discharge and death within 90 days. Disclosure: Dr. Weaver has nothing to disclose. Dr. Nappi has nothing to disclose. Dr. Bodhit has nothing to disclose. Dr. Ju has nothing to disclose. Dr. Applewhite has nothing to disclose. Dr. Hedna has nothing to disclose. Dr. Waters has nothing to disclose. Dr. Stead has nothing to disclose. more...

Objective: To determine whether prehospital vital signs are correlated with outcome after acute intracerebral hemorrhage. Design/Methods: This analysis included all adult patients who presented with an intracerebral hemorrhage during the study period. Patients with subarachnoid and subdural hemorrhages were not included. Prehospital data were obtained from EMS. Prehospital data collected included GCS, pulse, glucose, systolic and diastolic BP, and mean arterial pressure (MAP). Outcomes included stroke severity and Death. Stroke severity was determined by the NIHSS in the Emergency Department. Death after ICH was ascertained from follow up clinic visits, medical records, and the social security death index. Results: 50% of the cohort arrived by EMS. Table 1 depicts the median and interquartile ranges for the prehospital vitals. The median time from symptom onset to presentation was 103 minutes, with an interquartile range of 82 to 171 minutes. The median NIHSS was 16 (IQR 10-26). A total of 64% of the cohort died. Median days to death was 2, with an interquartile range of 1 to 13, and a total range of 0 to 26. Functional outcome as measured by the modified rankin score demonstrated a median of 5. Patients who has a low GCS in the field were significantly more likely to have more severe stroke (p= 0.0152, and have a worse functional outcome (p=0.0027), and higher risk of death (p=.0095). Similarly, patients with lower mean arterial pressure were also significantly more likely to have a higher risk of death (p=.0219). Elevated prehospital glucose was significantly associated with death (p=0.0336). Indeed hyperglycemia was significantly associated with poor outcome (p=0.0158 for NIHSS; and p= 0.0299 for Rankin) for the entire cohort, regardless of whether they came via EMS. Conclusions: Prehospital parameters appear to be correlated with worse outcomes after acute intracerebral hemorrhage. Disclosure: Dr. Bodhit has nothing to disclose. Dr. Ju has nothing to disclose. Dr. Nappi has nothing to disclose. Dr. Weaver has nothing to disclose. Dr. Applewhite has nothing to disclose. Dr. Hedna has nothing to disclose. Dr. Waters has nothing to disclose. Dr. Stead has nothing to disclose. more...

Objective: To determine if admission medical research council(MRC) motor strength grade and presence of vascular collateralization are predictors of outcome after endovascular intervention(EI) for acute stroke. Background Large vessel ischemia constitute 30-50% of all cerebrovascular events and EI are gaining importance in the management. There are few clinical indicators of poor outcome like NIH stroke scale, age, extent of territory, infarct volume among others. Design/Methods: Retrospective analysis of 62 patients who underwent EI (MERCI,penumbra,alligator,balloon angioplasty,stents or combination of these procedures) with or without concurrent t-PA for acute stroke from 2007-2011. All patients had head and neck CTA with perfusion and EI. Admission MRC motor grade and collateralization on CTA were independent variables. Modified collateral flow(CS) grading 0-3 for absent, ≤50%,>50% but Results: Median age=75; median motor grade=2,with an interquartile range0-3. 53% were discharged to acute rehab or home(good outcome). SNF placement was 16%(intermediate outcome). Hospice disposition and death was 30%(poor outcome). In the poor outcome category,100% had MRC grade 0-1. The motor grade was significantly associated with death/SNF;as well as worse functional outcome(p Conclusions: This preliminary data suggest Motor grade assessment serve as a robust predictor of outcome after acute stroke intervention. Limitations:Severe neglect,intubated/sedated patients,and previous stroke.Modified collateral flow score grading needs revision as there is a disparity between different grades especially grade 1 & 2. For example person with minimal collaterals (eg: 5%)is in the same category of CS 1 as the person with 49% collaterals, which has a huge bearing on clinical outcome. Disclosure: Dr. Hedna has nothing to disclose. Dr. Favilla has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Khaku has nothing to disclose. Dr. Stead has nothing to disclose. Dr. Gottipati has nothing to disclose. Dr. Gottipati has nothing to disclose. Dr. Waters has nothing to disclose. more...