1 / 31

Stroke Care in the Emergency Setting

Ann M. Hoff, MD ETC Physician Trinity Health. Stroke Care in the Emergency Setting. American Stroke Association. Guidelines for the Early Management of Adults with Ischemic Stroke (2007) “Time is Brain”. Stroke Facts. In the US, someone has a stroke every 40 seconds

lupita
Download Presentation

Stroke Care in the Emergency Setting

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Ann M. Hoff, MD ETC Physician Trinity Health Stroke Care in the Emergency Setting

  2. American Stroke Association • Guidelines for the Early Management of Adults with Ischemic Stroke (2007) • “Time is Brain”

  3. Stroke Facts • In the US, someone has a stroke every 40 seconds • Every 3-4 minutes, someone dies of stroke • > 700,000 strokes and > 150,000 stroke deaths each year • Stroke is the 3rd leading cause of death

  4. Stroke is the leading cause of long-term disability • Ischemic strokes account for 85% of all strokes • In 2009, stroke cost the US $68.9 billion

  5. Stroke Signs/Symptoms • 5 most common signs/symptoms • Sudden numbness/weakness of the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden dizziness, trouble walking, or loss of balance/coordination • Sudden severe headache with unknown cause

  6. Stroke Risk – Race/Ethnicity • African Americans have the double the risk of stroke in comparison to Caucasians • Hispanic Americans fall between Caucasians and African Americans • African and Hispanic Americans are more likely to die following a stroke than are Caucasians

  7. Stroke Risk - Age • Nearly one quarter of strokes occur in people under the age of 65

  8. Stroke Risk Factors • In 2003, approximately 37% of adults reported having two or more of the risk factors listed above.

  9. US Stroke Map

  10. Hospitalizations

  11. Mortality

  12. ND Hospitalizations

  13. ND Mortality

  14. Prehospital Management • EMS Utilization • 29-65% • 62-95% of EMS activations occurred by an individual other than the patient • Dispatcher identified 52% of patients ultimately proven to have had a stroke on the initial telephone conversation

  15. 19-60% present within 3 hrs • 14-32% present within 2 hrs • Decreased time to physician exam, CT, and neuro evaluation

  16. EMS Care • Rapid identification of stroke • Identification of possible stroke mimics • 19-31% • ABCs • Transport • Notify ER

  17. Community Ambulance

  18. Cincinnati Stroke Scale

  19. ACT F.A.S.T. • Facial Droop • Arm Weakness • Speech • Time

  20. Golden Hour of Stroke

  21. Emergency Room Care • The First 15 Minutes • Acute Stroke Protocol • Focused H&P • NIHSS • Labs • IVs • EKG • Weight • Alert pharmacy to possible need for tPA • Order CT scan

  22. Stroke Alert Team Response ER MD NeuroMD Recorder Radiologist EKG CT TECH LAB

  23. Clinical Assessment • http://www.youtube.com/watch?v=gUkQmY33Hhc&feature=player_embedded#!

  24. Treatment • Emergency Treatment • Based on results of head CT and time of symptom onset

  25. No blood on CT, < 3hrs from onset • Review inclusion/exclusion criteria • Obtain consent • If tPA given, admit to ICU for 24 hrs

  26. No blood on CT, > 3hrs & < 8 hrs • Off-label IV tPA up to 4.5 hrs • Further imaging may expand treatment options: • CT angiogram • IA tPA • Mechanical thrombectomy • MERCI clot retrieval system (8/2004) • Penumbra system (12/2007)

  27. No blood on CT, > 8 hrs • 325 mg of aspirin • Reduces early death • Reduces long-term disability

  28. Prevention • 1 in 8 stroke survivors will have another stroke within 5 years • Treatment of underlying cause is important • Education • Rehabilitation • PT/OT to relearn skills

  29. Resources • Management of Ischemic Stroke: Part 1. Emergency Room Management. Journal of Hospital Medicine. Vol 5; No1; January 2010. • Guidelines for the Early Management of Adults with Ischemic Stroke. Stroke 2007, 38:1655-1711; April 12, 2007. • CDC • American Heart Association • American Stroke Association • National Stroke Association • Mayo Clinic • Genentech

More Related