Stroke Medical Management
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Kim Jackson, Lucinda hampton, Admin, Simisola Ajeyalemi, 127.0.0.1, Karen Wilson, Claire Knott, Rucha Gadgil and Wanda van Niekerk
Introduction[edit | edit source]
The team approach to stroke management starts with Emergency Medical Services and continues at a hospital within a Stroke System of Care capable of delivering Acute Stroke Care in the Emergency Department and in a dedicated Stroke Unit.The goal for the acute medical management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within a short time frame. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk / benefit for thrombolytic intervention.[1] Patients presenting with Glasgow Coma Scale scores of 8 or less or rapidly decreasing Glasgow Coma Scale scores, require emergent airway control via intubation.
Goals of Emergency Management
- Support Vital Functions
- Restore Cerebral Circulation
- Reduce Neurological Deficits
- Prevent Progression and Cell Death
- Restore Patient to Optimal Level of Pre-Stroke Function
American Stroke Association Stroke Chain of Survival | |
Detection |
Patient/Bystander or EMS recognition of Stroke Signs & Symptoms |
Dispatch |
EMS Activation; Priority Dispatch & Response |
Delivery |
Prompt Triage - In the interest of saving time, some EMS actions can be accomplished enroute. Limit assessments / Care on scene to those that are urgently needed or clearly indicated by the patients presentation. Transport to most appropriate Stroke Hospital Prehospital Notification |
Door |
Immediate Emergency Department triage to high-acuity area |
Data |
Prompt Emergency Department Evaluation. Stroke Team Activation Lab Studies and Brain Imaging Time barriers at the hospital which should be minimised:
|
Decision |
Diagnosis and determination of most appropriate therapy; Discussion with Patient and Family |
Drug |
Administration of appropriate Drugs / Treatment / Interventions Tissue Plasminogen Activator (tPa) for the treatment of acute ischemic stroke must be given within 4.5 hours from the onset of symptoms. Ideally, tPA should be administered (“door to drug”) in less than 60 minutes after Emergency Department arrival. Evidence confirms that the sooner tPA is administered, the more optimal the results. |
Disposition |
Timely Admission to Stroke Unit, ICU, or Transfer Outcomes are best when patients are admitted directly to and receive care in a dedicated stroke unit, where recovery and rehab can begin immediately. Hospitals without full stroke care capabilities should have official transfer agreements with hospitals offering a full complement of stroke care, and patients should be transferred as soon as reasonably possible. |
Suspected Stroke Algorithm[edit | edit source]
Ischemic Stroke[edit | edit source]
In the case of an Ischemic Stroke, the more rapidly blood flow is restrored, the ore likely for improved recovery and fewer brain cell deaths. Primary treatment is aimed at breaking down the clot through means of medication (Thrombolysis) or mechanical removal of clot (Thrombectomy). Other treatments aim to minimisethe clot becoming larger or prevention of new clot formation by means of anticoagulant type medications such as Aspirin, Clopidogrel or Dipyridamole. In conjunction with this, overall patient medical condition should be managed including montoring of blood sugars, oxygen levels and hydration and providing adequate treatment for same[2].
Thrombolysis[edit | edit source]
Thrombectomy[edit | edit source]
Haemorrhagic Stroke[edit | edit source]
In the case of Haemorrhagic Stroke the main aim is to stop the bleeding as early as possible, often requiring Neurosurgical Intervention.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Adams H, Adams R, Del Zoppo G, Goldstein LB. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. Apr 2005;36(4):916-23.
- ↑ Verheyen G and Ashbury A. IN Physical Management for Neurological Conditions 3rd Edition. Southampton: Elsevier 2011 pp.12-13