ACLS review: Acute Stroke Part 1

Overall Goal of Stoke Care

· Minimize brain injury

· Maximize the patient’s recovery

Demographics

· Male to female ratio 1.25:1 for ages 55-64

· Male to female ratio 1.50:1 for ages 65-74

· Male to female ratio 1.07:1 for ages 75-84

· Blacks have almost twice the risk of a first stroke than whites

· In the US about 795,000 people suffer an new or recurrent stroke

· Stokes are the leading cause of death in the US

Stoke Facts

· 87% of strokes are ischemic

· 13% hemorrhagic (10% intracerebral and 3% subarachnoid)

Stoke Chain of Survival

· Rapid recognition and reaction to stroke warning signs

· Rapid EMS dispatch

· Rapid EMS system transport and prearrival notification to the receiving hospital

· Rapid diagnosis and treatment in the hospital

8 D’s of Stroke Care

· Detection: Rapid recognition of symptoms

· Dispatch: Early activation and dispatch of EMS by 911

· Delivery: Rapid EMS identification, management, and transport

· Door: Appropriate triage to stroke center

· Data: Rapid triage, evaluation, and management within the ED

· Decision: Stroke expertise and therapy selection

· Drug: Fibrinolytic therapy, intra-arterial strategies

· Disposition: Rapid admission to the stroke unit or critical care units

NINDS Critical In-Hospital Goals of Stoke Care

· Immediate general assessment by the stoke team, ER physician within 10 minutes of arrival

· Neurological assessment by stoke team or designee and CT scan performed within 25 minutes of hospital arrival

· Interpretation of the CT scan within 45 minutes of ED arrival

· Initiation of fibrinolytic therapy in appropriate patients within 1 hour of hospital arrival and 3 hours of symptom onset

· Door to admission time of 3 hours

Note: National Institute of Neurological Disorders and Stroke (NINDS)

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