Mobile Stroke Units—the Changing Face of Emergency Medicine Stroke Management

Wira, Charles; Aydin, Ani

doi:10.1007/s40138-020-00207-4

Cited by 5 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Point-of-care pCT is a well-explored imaging modality that can provide valuable imaging at the bedside 53 . Point-of-care pCT scanners are capable of non-contrast CT, CT angiography, and CT perfusion, which enables the detection of both anatomical lesions, including hemorrhage 54 and subacute ischemia 55 , and vascular abnormalities, such as an ischemic penumbra 56 and large-vessel occlusions 57 . Similar to pCT scanners, the low-field pMRI evaluated in this report can detect hemorrhage and ischemia.…”

Section: Discussionmentioning

confidence: 99%

Bedside detection of intracranial midline shift using portable magnetic resonance imaging

Sheth

Mazurek

Cahn

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07–40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11–2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.

show abstract

Section: Discussionmentioning

confidence: 99%

Bedside detection of intracranial midline shift using portable magnetic resonance imaging

Sheth

Mazurek

Cahn

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The introduction of portable CT scanners in the ambulance is an important recent innovation to improve early acute stroke management. The Mobile Stroke Units (MSUs) were initially introduced in Germany and the USA and are now available for the treatment of acute stroke patients in at least 30 stroke centres around the world [ 43 ]. In most instances, the MSU arrives at the site and the patient is examined by the stroke consultant or stroke fellow at the scene or via telestroke.…”

Section: Assessment Of the Patient With Suspected Acute Strokementioning

confidence: 99%

Stroke mimics: incidence, aetiology, clinical features and treatment

et al. 2021

View full text Add to dashboard Cite

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

show abstract

“…Together, the point-of-care laboratory, a CT scanner capable of performing a noncontrast brain CT, and the specialized stroke team can speed diagnosis, treatment, and triage, increasing treatment opportunities. 18 Although the reduction in time to thrombolysis has been the focus of the MSU, 10 the delivery of a patient to the most appropriate stroke center has become increasingly important. 19 Prehospital imaging and neurovascular assessment performed by a specialist ensure that patients are both treated at the earliest possible time and delivered to a center capable of supporting acute ischemic stroke (AIS) treatment.…”

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Section: Prehospital Stroke Care: Emergency Medical Services and Msusmentioning

confidence: 99%

Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Ashcraft¹,

Wilson²,

Nyström³

et al. 2021

Stroke

Self Cite

View full text Add to dashboard Cite

The year 2020 was the year of the nurse, celebrating nurse scholarship, innovation, and leadership by promoting scientific nursing research, improving nursing practice, advancing nursing education, and providing leadership to influence health policy. As architects of stroke care, neuroscience nurses play a vital role in collaborating and coordinating care between multiple health professionals. Nurses improve accessibility and equity through telestroke, emergency medical services, and mobile stroke units and are integral to implementing education strategies by advocating and ensuring that patients and caregivers receive stroke education while safely transitioning through the health care system and to home. Stroke care is increasingly complex in the new reperfusion era, requiring nurses to participate in continuing education while attaining levels of competency in both the acute and recovery care process. Advanced practice nurses are taking the lead in many organizations, serving as prehospital providers on mobile stroke units, participating as members of the stroke response team, and directing stroke care protocols in the emergency department. This scientific statement is an update to the 2009 “Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient.” The aim is to provide a comprehensive review of the scientific evidence on nursing care in the prehospital and hyperacute emergency hospital setting, arming nurses with the necessary tools to provide evidenced-based high-quality care.

show abstract

Mobile Stroke Units—the Changing Face of Emergency Medicine Stroke Management

Cited by 5 publications

References 34 publications

Bedside detection of intracranial midline shift using portable magnetic resonance imaging

Bedside detection of intracranial midline shift using portable magnetic resonance imaging

Stroke mimics: incidence, aetiology, clinical features and treatment

Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Contact Info

Product

Resources

About