Emergency medicine clinics of North America
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Acute stroke care is a multidisciplinary effort. It crosses the boundaries of traditional hospital-based medicine, relying heavily on prehospital providers to obtain a significant amount of clinical information. Currently, modifications of existing EMS systems are underway to support the idea that "time is brain." Dispatchers and EMS providers are vital players in the Chain of Recovery, and are challenged to perform within this new paradigm for acute stroke care. ⋯ The importance of using EMS during the initial phase of acute stroke cannot be overstated. Emergency physicians must lead in coordinating the resources, placing greater emphasis on educating and assessing the performance of prehospital providers [50]. These leaders must ensure that prehospital providers understand they are integral members of the stroke team, vital to improving stroke care in the community.
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The rapid neuroimaging of a patient that has suffered a stroke is a critical preamble to the emergent initiation of thrombolytic therapy. Emergency physicians must be familiar with normal brain structures as they appear on CT, as well as common stroke patterns. The more facile emergency physicians are at interpreting the head CT, the better they can communicate with consulting specialists and deliver prompt care to patients that present with neurologic emergencies.
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The landscape of acute stroke care has changed dramatically in the last decade. Even before the approval of tissue plasminogen activator for acute stroke in 1996, organized acute stroke care was initiated at several hospitals and the pharmaceutical industry was deeply entrenched in the search for neuroprotective agents. ⋯ Despite the failures of many neuroprotective agents and the relative lack of use of tPA, the acute treatment of the stroke has gained increasing importance both at an individual and national level. This chapter reviews some of the advances in the acute treatment of stroke, future of acute stroke care and discusses the emerging role of the emergency physician in this area.
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Emerg. Med. Clin. North Am. · Aug 2002
ReviewAcute ischemic stroke: emergent evaluation and management.
This article discusses stroke, the third leading cause of death and number one cause of adult disability in the United States, inflicting a devastating physical, emotional, and financial toll on its victims and their families. The last decade has seen the emergence of new treatments for acute stroke, energizing stroke care providers and spreading a sense of optimism among them. Because effective stroke treatment is extremely time-dependent, it is paramount that emergency physicians understand and excel in their critical role at the forefront of stroke management. This article outlines the emergent evaluation and management of acute ischemic stroke, emphasizing the importance of the emergency physician in acute stroke treatment.
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The diagnosis of acute stroke remains a clinical diagnosis in the initial phases of patient evaluation. There is a differential diagnostic process to the abrupt onset of focal neurologic deficit that characterizes an acute stroke. "Is this a CNS event?" might be the initial question posed by the clinician. The stroke mimics of systemic problems such as hypoglycemia, hyperglycemia, and other encephalopathies are considered. ⋯ The standard acute neuroimaging with noncontrast CT scanning uncovers some mass lesions mimicking stroke and confirm a stroke subtype in other patients. Ischemic stroke, like other common diseases, does have uncommon manifestations. Acute stroke is considered in neurologic syndromes in which abrupt onset of symptoms figure prominently, particularly in patients with cerebrovascular risk factors.