SKYAID
 New 
Mission
 Overview   
Details    
Medical   
Watch   
Heart attack  
Stroke    
World health  
Emergency
 Cost effective
 Media 
- Site Map 

SKYCAR   
Details   
Overview  
VTOL   
Airline   
Military   
Transportation
 Images 
- Site Map

Search

Translate 
   8 languages
 

Part 7: The Era of Reperfusion Section 2: Acute Stroke
Resuscitation 46(2000)239-252
Full article in PDF,  {PDF file 359KBytes} highlights follow   added 1/25/01
- - - - - - - -

The stroke rate is declining in most western and northern European countries, but there is a large and increasing rate in Russia, possibly attributable to a higher prevalence of hypertension [2]. Although stroke mortality and attack rates are falling in many countries, the gain achieved by prevention has been counterbalanced by a growth in the aging population (more people at risk) [3,4].

- - - - - -
Only half of stroke patients currently use the EMS system for transport to the hospital [11,22]. Strokes that occur when the patient is alone or sleeping may further delay prompt recognition and action [23]. Eighty-five percent of strokes occur at home [22]. As a result, public education programs have appropriately focused their efforts on persons at risk for stroke and their friends and family members. Public education has reduced the time to arrival at the ED [8,12].

Table 2 Cincinnati Prehospital Stroke Scale

  • Try to elicit one of the following signs (abnormality in any one is strongly suggestive of stroke):

  • Facial droop (have patient show teeth or smile):
    - Normal: both sides of face move equally well
    - Abnormal: one side of face does not move as well as the other side

  • Arm drift (have patient close eyes and hold both arms straight out for 10 seconds):
    - Normal: both arms move the same or both arms do not move at all (other findings, such as pronator grip, may be helpful)
    - Abnormal: one arm does not move or one arm drifts down

  • Abnormal speech (have the patient say `you can't teach an old dog new tricks'):
    - Normal: patient uses correct words with no slurring
    - Abnormal: patient slurs words, uses the wrong words, or is unable to speak

- - - - - - pg 244 - Possible Heart Rate Variability - - - -
Many patients have hypertension after an ischemic or hemorrhagic stroke, but few require emergency treatment. Elevated blood pressure after a stroke is not a hypertensive emergency unless there are other medical problems (eg, AMI or aortic dissection) [59].

Management of Seizures. - - - - - pg 245 - - - - - -
Recurrent seizures are a potentially life-threatening complication of stroke. They can worsen the stroke and should be controlled. Administration of anticonvulsant medications to prevent recurrent seizures is strongly recommended, but prophylactic administration is not indicated [59]. Protection of the airway, administration of supplementary oxygen, and maintenance of normothermia are part of supportive care.

Management of Increased ICP. - - - - pg 246 - - - - -
Death during the first week after stroke commonly is caused by brain edema and increased ICP. Fortunately only 10% to 20% of stroke patients develop brain edema sufficient to cause clinical deterioration.

- - rtPA- - pg 246 - - - - - -

The National Institute of Neurological Disorders and Stroke rtPA Stroke Trial [64] evaluated a single agent administered within 3 hours of symptom onset in a prospective, blinded, randomized, controlled clinical trial. Intravenous tPA was administered in a dose of 0.9 mg given as a 10% bolus over 1 minute, followed by a 1-hour infusion versus a placebo. In this trial, patients treated with tPA within 3 hours of onset of symptoms were at least 30% more likely to have minimal or no disability at 3 months compared with those treated with placebo. The risk of fatal intracranial hemorrhage, however, was 10 times greater in the tPA-treated group (3% versus 0.3%). A similar increase in the frequency of all symptomatic hemorrhages (6.4% versus 0.6%) was also observed in this group. This increase in symptomatic hemorrhage did not lead to an overall increase in mortality in the treated group.

Based on the results of parts I and II of the National Institute of Neurological Disorders and Stroke study, intravenous administration of tPA is recommended for carefully selected patients with acute ischemic stroke if they have no contraindications to fibrinolytic therapy and if the drug can be administered within 3 hours of the onset of stroke symptoms (Class I). Contraindications to tPA are listed in Table 10.