The Neurohospitalist
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The Neurohospitalist · Oct 2012
Neurohospitalists Improve Door-to-Needle Times for Patients With Ischemic Stroke Receiving Intravenous tPA.
It is unknown whether neurohospitalist evaluation improves door-to-needle times (DNT) in patients with acute ischemic stroke.The purpose of this study is to determine the impact of neurohospitalist evaluation on DNT for patients with ischemic stroke receiving intravenous tissue plasminogen activator (tPA) presenting within 4.5 hours of symptom onset. ⋯ Neurohospitialist evaluation is associated with faster DNT in patients with ischemic stroke. Neurohospitalist evaluation could be a part of a multidimensional initiative to improve the timeliness of tPA administration.
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Sepsis represents a major challenge in medicine. It begins as a systemic response to infection that can affect virtually any organ system, including the central and peripheral nervous systems. Akin to management of stroke, early recognition and treatment of sepsis are just as crucial to a successful outcome. ⋯ Stroke and traumatic brain injury can predispose a patient to develop sepsis, whereas Guillain-Barré syndrome is similarly not uncommon following infection. This review article will first describe the essential principles of sepsis recognition, pathophysiology, and management and will then briefly cover the neurologic aspects associated with sepsis. Vigilant awareness of the clinical features of sepsis and timeliness of intervention can help clinicians prevent progression of this disease to a multisystem organ failure, which can be difficult to reverse even after the original source of infection is under control.