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STROKE STEMO/ MSU a German Approach

STROKE STEMO/ MSU a German Approach. SYMPTOMS. Depend on the effected brain area Paralysis of Contralateral Arm/Leg and Face (Hemiplagia) or weakness (Hemiparesis) Aphasia (if in dominant hemisphere)/ Alexia Numbness in Limbs Altered smell, hearing or vision

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STROKE STEMO/ MSU a German Approach

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  1. STROKE STEMO/ MSU a German Approach

  2. SYMPTOMS Depend on the effected brain area • Paralysis of Contralateral Arm/Leg and Face (Hemiplagia) or weakness (Hemiparesis) • Aphasia (if in dominant hemisphere)/ Alexia • Numbness in Limbs • Altered smell, hearing or vision • 2 Types: Thrombosis (Obstruction) or Hemorrhage

  3. Acute Ischemic Stroke • 70-80% • Intracerebral Bleeding • 20-30%

  4. Statistics: • 270 000 cases a year (83mio citizen) • 20% fatal 3rd most common fatal disease • 70-80% Ischemic Stroke – 20-30% ICB

  5. Treatment: • -Thrombectomy • -Hemicraniectomy • -Trombolysis-via t-PA tissue plasminogen activator (only effective therapy considering time and infrastructure) • Time dependent (possible till max 4-4.5h) • Notice – Call – Arrival-transport-Hospitalisation- diagnosis-treatment • TIME IS BRAIN! • → MSU

  6. Stationary • emergency transport required • Localized in Emergency Deparment (Clinic) • Time limit for Thrombolysis often passed (4.5 h) • (52%) • Mobile Stroke Unit /STEMO • Diagnosis on scene • Thrombolysis on scene • Chain shortened to: • Notice-call-> no further time loss

  7. The MSU/STEMO • Truck based “Mobile intensice care unit” Type C (12t) -EN1789/En1865 • + mobile BGA + POC Lab • + mobile C-CT • +equipment for induced hyperthermia (neuroprotection) • allows preclinical Thrombolysis • Crew: • -1x Paramedic • -1x Emergency Physician • -1x Radiographer

  8. New approach for emergency treatment in Germany • Model study started 2008 (Saar), 2011 (Berlin) Results show: • Improvement dependent on location • In Regions with higher frequent Neurology departments / Stroke-Units no MSU required • In low frequent areas recommendable (MSU)

  9. Sources: • Emergency Neurology- L.Roos-Springer 2012 • Basiswissen Neurologie- P. Berlit- Springer 2007 • Acute Ischemic Stroke- Gonzales- Springer 2011 • German State Institute of Statistics - http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?p_uid=gastg&p_aid=&p_knoten=FID&p_sprache=D&p_suchstring=10404::Schlaganfall • Firedepartment Berlin http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?p_uid=gastg&p_aid=&p_knoten=FID&p_sprache=D&p_suchstring=10404::Schlaganfall

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