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.
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!)