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Study Objective: A paucity of data exists on the impact emergency department (ED) pharmacists have on a stroke team's door-to-needle (DTN) administration time of recombinant tissue plasminogen activator (rTPA). The purpose of this study was to assess the odds of achieving a DTN administration time for rTPA of 60 minutes or less with an ED pharmacist present.Methods: This was a retrospective, cohort study of patients who received rTPA for acute ischemic stroke (AIS) from May 2017 to May 2018. Patients were included if they were at least 18 years old and received tPA for AIS in the ED. The primary outcome for this study was the likelihood of patients receiving a DTN administration time of 60 minutes or less with or without an ED pharmacist present during a stroke alert at a primary stroke center.Results: The electronic medical record of 184 stroke alert patients was reviewed, and 65 patients were included in the final analysis. Baseline characteristics were similar in all aspects.The odds ratio was 3.3 (95% confidence interval [CI]: 1.1-9.6; P = 0.04) to achieve a DTN administration time of 60 minutes or less when an ED pharmacist was present. The ED pharmacist present group had faster median (47 minutes vs 60 minutes; P = 0.001) and average (49 minutes vs 63 minutes; P = 0.003) DTN administration times compared with the ED pharmacist not present group.Conclusion: An ED pharmacists present during a stroke alert at our faculty resulted in reduced overall DTN rTPA administration times and increased the odds of a patient receiving rTPA less than 60 minutes from arrival for AIS. Further study is required to determine if this finding can be replicated in other EDs. K E Y W O R D Sclinical pharmacist, stroke, thrombolytic

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Purpose A case of alteplase administration to a patient with vasculitis and acute ischemic stroke (AIS) is reported. Summary A 38-year-old woman with a recent diagnosis of granulomatosis with polyangiitis (GPA) received alteplase for AIS and developed symptomatic hemorrhagic conversion. Published reports regarding the safety of thrombolytic therapy in patients with a high inflammatory burden are inconsistent. The current case adds to the literature on the topic. Conclusion More data regarding alteplase treatment in patients with GPA are needed to further establish the safety of this therapy.

The objective of our study was to assess the percentage of patients who met qSOFA criteria, SIRS criteria, both, or none of either criterion and received an International Classification of Diseases, Tenth Revision (ICD-10) code for sepsis after admission from the emergency department (ED). This was a single-center retrospective chart review of medical patients admitted through the ED. Patients were included if they were older than 18 years, were admitted to an inpatient unit through the ED, and received antibiotics within 48 hr of admission. All patients included were evaluated for the presence of SIRS and qSOFA criteria and then stratified into 1 of 4 groups. Group 1 consisted of patients who exhibited neither SIRS criteria nor qSOFA criteria (fewer than 2 of both SIRS and qSOFA criteria). Group 2 consisted of patients with only SIRS criteria (more than 2 SIRS criteria but fewer than 2 qSOFA criteria). Group 3 consisted of patients with only qSOFA criteria (more than 2 qSOFA criteria but fewer than 2 SIRS criteria), and Group 4 consisted of patients with both qSOFA and SIRS criteria (more than 2 qSOFA and SIRS criteria). A of total 100 patients were included, with 49 patients stratified into Group 1, 37 into Group 2, 2 into Group 3, and 12 into Group 4. With respect to the primary endpoint, Group 1 had a total of 7 patients (14.3%) who received an ICD-10 code for sepsis or septic shock, Group 2 had 15 patients (40.5%), Group 3 had 1 patient (50%), and Group 4 had 9 patients (75%). The utilization of both qSOFA and SIRS criteria resulted in a higher percentage of patients who were designated an ICD-10 code for sepsis whereas patients who did not exhibit either criterion still had roughly 15% of patients designated an ICD-10 code for sepsis.