An Ischemic stroke occurs when a clot forms or lodges in one of the arteries of the brain, causing a loss of blood supply to the affected area. Ischemic strokes account for more than 85% of all strokes. The goal is to act fast- within 3 hours of onset of symptoms (or 4.5 hours for a select group of patients) to break up the clot and restore perfusion. In order to accomplish this, several things must fall into place.
AHA guidelines reflect the need for a patient to undergo a whole set of procedures upon entering the ER doors in order to minimize delays.
1) Within 10 minutes of arrival, the patient should undergo a doctor's evaluation, including a stroke screen assessment, history (noting time of onset of symptoms) and lab work including a bedside blood sugar.
2) The stroke team, including neurological experts, should be notified within 15 minutes.
3) The patient should have a CT scan within 25 minutes of arrival. this is the only way to be sure that the stroke is ischemic versus hemorrhagic.
4) Within 45 minutes, the CT results and basic lab work should be reviewed, and the patient's eligibility for clot busting Tissue Plasminogen Activator (TPA) intravenously should be established.
5) TPA should be initiated within 60 minutes of the patient's arrival.
These guidelines for the "golden hour of stroke care" were established after several studies showed that patients receiving TPA could have dramatic symptom reversal, and maximize their neurological potential after suffering a stroke.
Patients should be triaged to the nearest stroke center if being transported by EMS. For example- if CT is not available at one hospital, the patient should be diverted to another facility with the capability to perform all of the steps outlined above.
TPA is not without significant risks, most notably life threatening bleeding internally or externally.
AHA guidelines reflect the need for a patient to undergo a whole set of procedures upon entering the ER doors in order to minimize delays.
1) Within 10 minutes of arrival, the patient should undergo a doctor's evaluation, including a stroke screen assessment, history (noting time of onset of symptoms) and lab work including a bedside blood sugar.
2) The stroke team, including neurological experts, should be notified within 15 minutes.
3) The patient should have a CT scan within 25 minutes of arrival. this is the only way to be sure that the stroke is ischemic versus hemorrhagic.
4) Within 45 minutes, the CT results and basic lab work should be reviewed, and the patient's eligibility for clot busting Tissue Plasminogen Activator (TPA) intravenously should be established.
5) TPA should be initiated within 60 minutes of the patient's arrival.
These guidelines for the "golden hour of stroke care" were established after several studies showed that patients receiving TPA could have dramatic symptom reversal, and maximize their neurological potential after suffering a stroke.
Patients should be triaged to the nearest stroke center if being transported by EMS. For example- if CT is not available at one hospital, the patient should be diverted to another facility with the capability to perform all of the steps outlined above.
TPA is not without significant risks, most notably life threatening bleeding internally or externally.
