Guidelines for the Early Management of Adults With Ischemic Stroke

Abstract

Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Key Words: AHA Scientific Statements Ⅲ emergency medical services Ⅲ stroke Ⅲ acute cerebral infarction Ⅲ tissue plasminogen activator †Deceased. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Methods-Members

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

“…At admission, measurement of serum cardiac troponin I and ECG were routinely performed in all patients following the guidelines since 2007 3. After cardiac investigation, additional cardiac evaluations of patients were performed by cardiologists if the tests were suspected of indicating acute coronary syndrome 4.…”

“…Thus, since 2007, the guidelines for the management of ischemic stroke recommend to perform a 12‐lead electrocardiography and cardiac enzyme test,3, 4 particularly cardiac troponin, which is a highly sensitive and specific biomarker of myocardial damage 5…”

Canadian Association of Emergency Physicians Position Statement on Acute Ischemic Stroke

“…Prehospital triage and transportation protocols should identify facilities locally or regionally designated to receive acute stroke patients and bypass more proximal facilities in favor of transporting to these sites, assuming the absence of other immediately life-threatening conditions (STRONG RECOMMENDATION, MODERATE QUALITY EVIDENCE). 5,7,10,11 2. Emergency departments that treat acute stroke patients should have "Code Stroke" protocols or stroke teams to rapidly assess, image and treat patients with the highest priority (STRONG RECOMMENDATION, MODERATE QUALITY EVIDENCE).…”

“…Emergency departments that treat acute stroke patients should have "Code Stroke" protocols or stroke teams to rapidly assess, image and treat patients with the highest priority (STRONG RECOMMENDATION, MODERATE QUALITY EVIDENCE). 10 3. Designated stroke centers should be identified within regions to receive acute stroke patients; these centers should have organized inpatient (stroke unit) services (STRONG RECOMMENDATION, STRONG QUALITY EVIDENCE).…”

“…10 One goal of hospital admission post-stroke is to observe for changes in patient condition that may herald the need for further intervention. In the subset of patients who have received tPA, minimizing the risk of and monitoring for complications is an important aspect of this care.…”