Week 5: Guidelines for Acute Stroke, part 1

So, I wanted to start off by actually reading the AHA/ASA guidelines for how to manage acute stroke. The only thing is it’s almost 80 pages, which counts as a little more than my article for the day. So I’m tackling it in chunks, which may take a couple days.

#13: Guidelines for the early management of patients with acute ischemic stroke

Section 1: Public Stroke Education through General Supportive Care

  • We need to do a better job with public education. Only half of 911 calls for stroke are made within an hour of when symptoms start, and only 53% of stroke patients use EMS.
  • Comprehensive stroke centers had no mortality difference on weekends, vs all other stroke centers that had higher mortality on weekend days
  • For each 15 minute decrease in time to tPA administration, there is a 5% reduction in in-hospital mortality
  • If patients have on-and-off symptoms that completely resolve, the last-known-well clock gets reset.
  • Don’t wait for coags to come back unless there is a reason to suspect they will be abnormal.
  • Hyperdense MCA sign is present in 1/3 to 1/2 of the cases with demonstrated thrombus.
  • Hypotension on presentation is rare: <3% in a couple of large series
  • Stroke patients that get intubated have a 50% 30-day mortality (yikes!)

More tomorrow…

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4 Comments

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4 responses to “Week 5: Guidelines for Acute Stroke, part 1

  1. Pingback: Week 5: Guidelines for Acute Stroke, part 2 | Evidenced

  2. Pingback: Week 5: Guidelines for Acute Stroke, part 3 | Evidenced

  3. Pingback: Week 5: Acute Stroke Guidelines, part 4 | Evidenced

  4. Pingback: Week 6: Management of Acute Stroke, part 1 | Evidenced

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