VOLUME 2, ISSUE 05

A ERO M E D O UT R EAC H
MAY 2020

HAPPY RETIREMENT & THANK YOU FOR YOUR SERVICE

INSIDE THIS
ISSUE:

SPOTLIGHT 1

PHYSICIAN’S 2
ARTICLE– MAY

PHYSICIAN’S 3
ARTICLE– MAY
CONTINUED

OUT & ABOUT 4

WITH AEROMED

OUT & ABOUT 5

WITH AEROMED

UPCOMING
OUTREACH
ACTIVITIES

Flight Nurse and Paramedic Heather Collins will be celebrating 45 years of service to
• Babcock Ranch Tour
Tampa General Hospital and 31 years of service to Aeromed in June! While we are
and Presentation
June 4th excited for Heather to enjoy the new adventures of retirement, we know that she will be
truly missed by her colleagues, her patients, and the air medical industry.
• Critical Care Review
Heather has been instrumental in developing, implementing, and monitoring many
Course June 5th-8th
safety and quality practices and programs throughout her years of service. Her
• Miller Dynamics and contributions to nursing and flight medicine will be long felt through her education,
Sebring Raceway training, and mentoring of students and peers.
Safety Team Trauma Everyone knows you can always count on being greeted with a smile, kindness, and
Scenario and HEMS compassion when Heather is around! Her partners and colleagues share similar
Operations Presenta- feelings- “ She is one of the kindest and most loving people I have ever met”. (TB)
tion June 9th “ I can’t possibly articulate how I highly I think of her. Heather is the most genuine, kind,
and compassionate human I have ever met. She brings calm to the storm”. (AB)
• Prehospital Treat-
ment Goals for Heather has helped to define mentorship, leadership, and colleagueship within our
Trauma Patients— community.
Blake Trauma Grand Please join us in congratulating Heather on her many accomplishments and thanking her
Rounds June 25th for a job truly well done!

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 AEROMED OUTREACH
Physician Article May– STROKE MIMICS
Stroke Mimics
Not infrequently, as physicians, after evaluating a patient in the
ED we have several working diagnoses with which the patient gets
admitted. The patient then has additional work up done on the
floor and that list of several, hopefully gets down to 1. That is if
there was only one problem going on. The broader an emergency
physician can think when evaluating a patient and following up to
see what the final diagnosis is when a patient is admitted, the
better he or she will be able to evaluate the next patient with simi-
lar complaints.
Even more so, as first responders, the list of possible diagnoses
with which you first see a patient on scene is extensive. Based on
your initial evaluation of a patient on scene, an appropriate deci-
sion is made to bring the patient to the hospital where that list of
possible diagnoses shrinks. The more comprehensive your list of
possible diagnoses will be the better you will be able to evaluate
patient’s on scene.
Although a patient may arrive to the hospital as a “stroke alert”, it
is only upon further work up and a diligent history that the diagno-
sis is made. Below we will look at several imitators of stroke that
both EMS personnel and physicians need to be aware of.
Stroke mimics comprise as many as 20% - 25% of suspected
stroke presentations. That is non-vascular disorders that result in
focal neurologic deficits. Because certain interventions such as
tPA/fibrinolysis can have harmful effects, it is important to consid-
er and identify stroke mimics. Five of the most common mimics
include, hypoglycemia, Todd paralysis, cerebral neoplasm, hemi-
plegic migraine, and functional hemiparesis.
Hypoglycemia
Defined as serum glucose below 70mg/dL and considered severe
below 45mg/dL. Hypoglycemia is the most commonly known
stroke mimic. This non-vascular etiology of neurologic deficits can
cause focal deficits such as hemiplegia, blindness, aphasia. Of
note there have also been reports that these symptoms can per-
sist for hours after glucose administration. Other electrolyte and
metabolic derangements can present similarly to hypoglycemia,
however hypoglycemia is the one that can be most rapidly identi-
fied and corrected, even before arriving to the ED.
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Page 2
Todd Paralysis
Todd paralysis is a condition that occurs post seizure. It manifests
as transient neurologic paralysis that occurs without an organic
cause in the nervous system. This typically occurs in the postictal
state and can simulate a stroke, with focal weakness. These symp-
toms are temporary however may persist for 1-2 days. It is im-
portant therefore to obtain a history of seizures from bystanders or
patient’s family when evaluating a patient for a stroke. This may
help in further evaluation of the patient in the ED.
Cerebral Neoplasm
An intracerebral mass can present with stroke like symptoms, such
as visual changes, weakness, slurred speech. These symptoms are
typically due to tumor compressing different areas of the brain
resulting in the neurologic symptoms that mimic strokes. Although
these symptoms are commonly slow in onset, up to 6% of patient’s
with brain neoplasms can present with symptoms that have been
there for less than one day.
Hemiplegic Migraine
Up to 9% of stroke mimics can be attributed to headache disorders.
Familial hemiplegic migraine for example, is a migraine variant that
consists of aura with fully reversible motor weakness. It is an inher-
ited disorder and typically affects females. As with many of these
mimics, this is a diagnosis of exclusion, however keeping it in mind
can connect the dots when you see a patient with stroke like symp-
toms and headache repeatedly despite negative imaging and neu-
rologic workup.
Functional Hemiparesis
Conversion disorder is a mental condition that can produce func-
tional neurologic symptoms that have no explanation based on
known medical etiologies. It is important to note that the symp-
toms are not intentionally produced by the patient. Typically, the
exam will be inconsistent with known stroke patterns, or the pa-
tient will have symptoms intermittently depending on tasks.
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Physician Article May cont.– STROKE MIMICS

Others

Meningitis, MS, vestibular neuritis, dementia, infection, sepsis, intoxication.

In summary, given the fact that many stroke mimics exist, diligence and care must be taken to identify mimics before administering
potentially harmful medications and stroke treatments. It is important to have a broad differential when considering a patient with focal
neurologic deficits.

Mikhail Marchenko, MD
USF Emergency Medicine, PGY-2

References:

Fernandes PM, Whiteley WN, Hart SR, Al-Shahi Salman R. Strokes: mimics and chameleons. Pract Neurol. 2013;13(1):21‐28.
doi:10.1136/practneurol-2012-000465

Tobin WO, Hentz JG, Bobrow BJ, Demaerschalk BM. Identification of stroke mimics in the emergency department setting. J Brain Dis.
2009;1:19‐22. Published 2009 Mar 31. doi:10.4137/jcnsd.s2280

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 AEROMED OUTREACH
OUT & ABOUT WITH AEROMED
We welcomed the month of May
as we were able to work towards
returning to a semblance of
normalcy. While the health and
safety of our crew, our partners,
and our patients remain our
priorities, we were able to
implement safe strategies that
allowed us to begin to return to
education, training, and
conferencing.
We hosted a Pediatric
Presentation with Hardee Co. May
13-15th. While practicing safe
distancing and hygiene we were
excited to utilize our pediatric high
fidelity simulator with our EMS
partners for the first time!
The week of May 17th we
celebrated National EMS Week.
We kicked off the week with a
Thank You video shared with our
EMS colleagues.
Page 4
If you missed the video, you can
check it out at:
https://youtu.be/P4U9obXF3D4
With the help of TGH Emergency
Services and Trauma Services we
finished our week of celebration
with a Grab-N-Go Lunch for the
EMS crews at Tampa General.
Thank you to Concur and SAP for
their gracious donations to help
support our EMS crews and
Metropolitan Ministries.
On May 22nd we had an excellent
Advanced Airway Presentation in
Glades Co. Again, we were able to
utilize Pedi-Sim and included the
use of GlideScope Go video
laryngoscopy. We also included a
surgical airway lab!
Please enjoy some of the highlights
of the month! Stay safe and
healthy~
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OUT & ABOUT WITH AEROMED–

THANK YOU TO ALL OF OUR EMS PARTNERS!

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