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Stroke is an emergency. Therefore it must be considered the same level of emergency as acute MI. Trauma emergency
medical service (EMS) dispatchers can reliably recognize stroke symptoms after training. Consultation of primary
care physician almost doubles the time from onset to hospital arrival. Today an uniform emergency phone number
is available in cases of emergency in most parts of Europe. EMS transportation may use priority signals.
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The Chain of Survival
The most important question is, how much time is justified for the different steps (American Stroke Association recommendations)? |
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Emergency Room Procedures
After referral, emergency room procedures must be perfectly orchestrated |
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Acute stroke is now recognized as a medical emergency. Acute, post-acute and rehabilitation care of stroke
patients in specialized wards, as well as revascularizing therapies, have been proven to be effective in acute ischaemic
stroke. The role of emergency physicians in trials of acute stroke therapy is expanding. At a large urban teaching
hospital with a comprehensive stroke intervention program emergency physicians can classify patients with stroke,
particularly haemorrhagic stroke.
References:
Kothari et al. Stroke 1995; 26 (6): 937-941.
Kothari et al. Stroke 1995; 26 (12): 2238-2241.
Kaste et al. Cerebrovasc Dis 2000; 10 (Suppl 3): S1-S11.
The Chain of Survival
The most important question is, how much time is justified for the different steps
(American Stroke Association recommendations)?
The chain of survival includes:
- Onset to treatment time
- Alarm to pick-up time (emergency 911 call)
- Transportation time to medical centre
- Door to needle time
- Door to CT time (Emergency room procedures, Diagnostics)
- CT to treatment time (Stroke Unit)
Motor deficits and speech problems were the most dramatic symptoms that led to activation of the EMS. Because EMS
dispatchers determine the response priority for these calls, dispatchers should be able to recognize the signs
and symptoms of stroke based on their telephone interviews.
References:
Kothari et al. Stroke 1995; 26 (6): 937-941.
Kothari et al. Stroke 1995; 26 (12): 2238-2241.
 
Emergency Room Procedures
After referral, emergency room procedures must be perfectly orchestrated:
- Concept of door to needle time
- Immediate assessment
- Clinical and neurological
- Diagnostic tests
- Computed tomography (CT)
- Ultrasound
- Cardiac
- Blood chemistry
Even within the hospital, a lot of time can be lost. The concept of "door to needle time"
is important, because it exemplifies the need for well-orchestrated procedures within a hospital. Currently, in many
hospitals a lot of time is lost while patients wait for a CT-scan or for the reading of a CT-scan. The American Stroke
Association has, therefore, issued time estimates for various hospital procedures, which seem very demanding (and are).
Nevertheless, emergency personnel should consider these estimates as goals that they should strive to reach.
The immediate assessment comprises both clinical and neurological examinations, and the perfect orchestration of urgent
diagnostic tests that include CT or other imaging methods, in some instances ultrasound and cardiac evaluation, and,
of course, blood chemistry.
References:
EUSI Recommendations. 2002, www.eusi-stroke.com
Kothari et al. Stroke 1995; 26 (6): 937-941.
Kothari et al. Stroke 1995; 26 (12): 2238-2241. |
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© 2005 Boehringer Ingelheim GmbH, Germany. All rights reserved.
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