Prehospital Stroke Care
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This document discusses prehospital stroke care. It notes that time is critical, as brain cells die every minute after a stroke occurs, increasing the risk of permanent damage. Key strategies to reduce treatment time include emergency medical service pre-notification, activating a stroke team with a single call, rapid brain imaging, and acute stroke management protocols. Guidelines for prehospital stroke systems recommend fast symptom recognition, determining the hospital destination before transport, and using telemedicine to help identify appropriate treatments and notify hospitals. The future of prehospital stroke care could see more use of technologies like tele-stroke and stroke emergency mobile units to further reduce time to treatment.
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Approach to a patient with Q wave abnormality in ECG
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THE LATEST IN STROKE MANAGEMENT, ACUTE AND PREVENTIVE By Arlyn Valencia, M.D....Arlyn Valencia, M.D.
A CONCISE OVERVIEW OF THE LATEST IN STROKE EPIDEMIOLOGY, ACUTE INTERVENTION AND PREVENTIVE MANAGEMENTEarly management of acute ischemic stroke cases
The document discusses protocols and guidelines for the early management of acute ischemic stroke cases at Apollo Hospitals in Hyderabad, India. It outlines the multidisciplinary approach used, including establishing an acute stroke team, developing treatment algorithms and clinical pathways, and implementing systems to reduce time-to-treatment such as an acute stroke alert SMS system. The goals are to complete initial evaluations, imaging, and assessments quickly and provide urgent interventions and specialized stroke care to limit mortality and morbidity from stroke.
Core measures version 3
Core measures are evidence-based practices established by healthcare organizations to improve outcomes for conditions like myocardial infarction (MI). MI occurs when plaque builds up in arteries and restricts blood flow to the heart. Left untreated, it can cause permanent heart damage or death. Hospitals are accountable for following core measures, like administering aspirin upon arrival, to provide structured, guideline-driven care proven to increase survival and recovery rates. Nurses play a key role by quickly recognizing MI symptoms, starting interventions, and closely monitoring patients through treatment and recovery. Overall, core measures benefit both patients and facilities by standardizing high-quality care focused on the best outcomes.
Emergency Medicine Research
A/Prof Marcus Ong
Consultant, Senior Medical Scientist
& Director of Research
Department of Emergency Medicine
Singapore General Hospital
EmergencyMedicine Research
A/Prof Marcus Ong
Consultant, Senior Medical Scientist
& Director of Research
Department of Emergency Medicine
Singapore General Hospital
MT Workshop Patient selection.pptx
This document provides guidance on patient selection for mechanical thrombectomy in acute ischemic stroke. It discusses key factors such as time from last known normal, vessel occlusion location, imaging findings on non-contrast CT and CTA/CTP. Patients within 6 hours should have an NIHSS ≥6, ASPECTS ≥6, pre-stroke mRS 0-1 and occlusion of the ICA or M1 segment. Between 6-24 hours, perfusion imaging can identify patients with clinical-radiological mismatch. The DAWN and DEFUSE3 trials expanded the window showing benefit for thrombectomy out to 16-24 hours in selected patients. Special scenarios like posterior circulation strokes and patients with preexisting disability are also reviewed. Mechanical
2016: National Acute Stroke Protocol Standard of Care and Emerging Technology...
1. The document outlines the national acute stroke protocol presented by Dr. Thomas Osborne.
2. It discusses evaluating patients based on symptoms and history, administering tPA within 3 hours of onset based on CT exclusion criteria, and using imaging to identify tissue at risk of infarction.
3. Advanced technologies like perfusion imaging are helping shift from a time-based to physiology-based approach by identifying the ischemic core and penumbra.
Patient selection and functional outcomes by Dr Ashutosh Hardikar
Patient selection and functional outcomes by Dr Ashutosh HardikarCICM 2019 Annual Scientific Meeting
Introduction: Recent times have witnessed almost half, or sometimes more cardiac surgical procedures are performed in patients above 75 years of age. Traditionally, the EuroSCORE II and STS risk scoring systems have been widely used across the globe. Extensive reviews have shown that EuroSCORE II probably overestimates the perioperative risk at lower score levels while the STS score tends to underestimate the risk.
Frailty is a broad term that encircles aspects of nutrition, lack of agility, inactivity, lack of strength and wasting; and is seen in 25-50% of elderly patients. It has been defined as a geriatric syndrome reflecting a state of reduced physiological reserve and increased vulnerability to poor resolution of homeostasis after a stressor event. Conversely, pre-frailty, which is potentially reversible, is associated with higher risk of older adults developing cardiovascular disease.
Frailty assessment includes a variety of physical and cognitive tests, functional assessments and evaluating nutritional status. Literature has highlighted what is referred to as the ‘obesity paradox’, meaning obese patients with heart failure fair better than leaner patients, possibly because they have more metabolic reserve and also because weight loss in itself is a risk factor for frailty.
Patient Selection: To comprehensively assess a patient, factors that describe the biological status of the patient should be incorporated. There are various methods of assessment and modified Fried criteria or comprehensive assessment of frailty are a couple of systems commonly used.
Conclusion: Systematic reviews have shown that frail patients have higher chance of mortality, major adverse cardiac and cerebrovascular events and functional decline after cardiac surgery. A holistic assessment not only categorises patients into the apt risk category and hence match goals and treatments; but also, will pick up patients with pre-frailty who will benefit from multidisciplinary intervention and be better prepared for the intervention. How to manage delays in stroke treatment Jacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
Role of anticoagulant in cardioembolic stroke-final.pdf
1. Anticoagulants such as warfarin and novel oral anticoagulants (NOACs) are used for secondary prevention of cardioembolic ischemic stroke.
2. The optimal timing to start anticoagulant therapy after an ischemic stroke is unclear but should be based on individual risk assessment considering factors like stroke severity, imaging findings, and risk of hemorrhagic transformation.
3. Clinical trials found that NOACs without prior bridging therapy may have a more favorable risk-benefit profile compared to warfarin in patients with ischemic stroke and atrial fibrillation.
Neurointervention in hemorrhagic and ischaemic stroke
This document discusses recent advances in neurointerventional treatment of hemorrhagic and ischemic stroke. It summarizes treatments for aneurysms, carotid artery stenosis, intracranial atherosclerosis, and cerebral arteriovenous malformations. Endovascular coiling is now the primary treatment for aneurysms in over 90% of cases. For carotid artery stenosis, stenting and endarterectomy are considered equivalent treatment options. Mechanical thrombectomy devices have improved recanalization rates for large vessel occlusions in acute ischemic stroke compared to intravenous thrombolysis alone. A multidisciplinary team approach including neurointervention, neurosurgery, and neurocritical care is emphasized.
Rescue icp
Presentation to
1. Accident & Emergency registrars, Royal London Hospital, London
2. Neuroscience Meeting, Royal London Hospital, London
Sophisticated Prehospital Stroke Systems of Care
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
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- Motor fluctuations are a common complication of Parkinson's disease that occur in approximately one-third of patients after 2 years of levodopa therapy. They involve unpredictable switching between "on" periods where symptoms are relieved and "off" periods where symptoms return.
- Management of motor fluctuations involves both non-pharmacological and pharmacological approaches. Non-pharmacologically, diet, exercise, and treating constipation may help. Pharmacologically, increasing levodopa doses, adding COMT inhibitors, dopamine agonists, or MAO-B inhibitors can help reduce off periods.
- There is no single best treatment, as the appropriate treatment depends on each individual patient's fluctuation patterns, symptoms, risk factors, and other considerations
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Management of Benzodiazepine Misuse and Dependence.pptx
The document discusses the management of benzodiazepine misuse and dependence. It notes that long-term benzodiazepine use has been associated with increased risks, harms, and mortality. The management of benzodiazepine dependence involves preventing misuse through short prescriptions, substituting to longer-acting benzodiazepines or other drugs, gradually tapering doses to avoid withdrawal symptoms, and using psychotherapy or other pharmacological interventions during tapering. Abrupt discontinuation can cause seizures, so slow tapering is generally recommended.
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This document discusses tauopathies, which are neurodegenerative diseases characterized by abnormal tau aggregates in neurons and glial cells. Tau is a microtubule-associated protein that promotes cytoskeleton structure and axonal transport in the nervous system. In tauopathies, tau becomes pathological and forms inclusions like paired helical filaments. Tauopathies show heterogeneity in clinical presentations depending on the type and location of tau aggregates. Classification is based on the tau isoforms involved, with 4-repeat tauopathies including progressive supranuclear palsy and corticobasal degeneration. Understanding tau aggregation mechanisms and their role in toxicity is important for developing targeted therapies for these diseases.
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Prehospital Stroke Care
- 1. Prehospital Stroke Care dr. Ade Wijaya, SpS
- 2. WHO Stroke Definition “Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.”
- 4. Risk Factors
- 6. Time is Brain brain cells die every minuteincreasing the risk of permanent brain damage, disability, or death 2 million
- 7. Stroke and Death 30% die More than
- 9. Ischemic Stroke Treatment < 24 hours< 4.5 hours
- 10. Key strategies identified to meet this goal include: • Emergency medical service pre-notification • Activating the stroke team with a single call • Rapid access to and interpretation of brain imaging • Specific protocols and tools for acute stroke management • A team-based approach Fonarow GC, Smith EE, Saver JL, Reeves MJ, Hernandez AF, Peterson ED, et al. Improving door-to-needle times in acute ischaemic stroke. The design and rationale for the American Heart Association/American Stroke Associations’s Target: Stroke initiative. Stroke 2011;42:2983-2989. Door To Needle Time Door to needle of ≤ 60 minutes in 50% of patients with ischemic stroke The American Heart Association/American Stroke Association
- 11. Fast Recognition of Stroke
- 12. Posterior vs. Anterior Infarction
- 13. Wen-Dan Tao. Stroke. Posterior Versus Anterior Circulation Infarction, Volume: 43, Issue: 8, Pages: 2060-2065, DOI: (10.1161/STROKEAHA.112.652420) Posterior vs. Anterior Infarction
- 14. Posterior vs. Anterior Infarction Wen-Dan Tao. Stroke. Posterior Versus Anterior Circulation Infarction, Volume: 43, Issue: 8, Pages: 2060-2065.
- 15. BEFAST vs. FAST
- 16. Prehospital Stroke Care Where Are We Now?
- 18. Onset to Hospital Time Premier Jatinegara Hospital, Jakarta January – June 2020 < 4,5 hours > 4,5 hours 60 % 40 %
- 19. Prehospital Stroke Care What to Achieve in the Future?
- 20. Tele-Stroke
- 21. Potentials: - Reduce time to tPA treatment - Earlier start to warfarin reversal or BP reduction in ICH - Identify patients suitable for endovascular / neurosurgical treatments - Comprehensive prenotification to inhospital facilities Limitations: - Diagnostic accuracy may be weakened - High cost Stroke Emergency Mobile Unit
- 22. Audebert HJ, Saver JL, Starkman S, Lees KR, Endres M. Prehospital stroke care: new prospects for treatment and clinical research. Neurology. 2013 Jul 30;81(5):501-8. New Prospects of Prehospital Stroke Care
- 25. Guidelines Guideline: EMS Assessment and Management
- 28. Take Home Messages • Time is a key factor in stroke care; TIME IS BRAIN • To reduce time to treatment, good prehospital care is necessary: - Fast stroke symptoms recognition (BE-FAST) - Emergency medical service pre-notification - Telemedicine and stroke emergency mobile unit • Determine hospital destination before patient transport GuidelinesTake Home Messages
- 29. Thank You