Elsevier

Apollo Medicine

Volume 10, Issue 4, December 2013, Pages 328-336
Apollo Medicine

Article on Quality
Early management of acute ischemic stroke cases: (Acute Stroke Protocols & Guidelines/Algorithms) @ Apollo Hospitals, Hyderabad

https://doi.org/10.1016/j.apme.2013.11.002Get rights and content

Abstract

Stroke is a medical emergency, with a mortality rate higher than most forms of cancer. It is the second leading cause of death in developed countries and is the most common cause of serious, long-term disability in adults. The incidence of stroke is increasing with the aging of populations and hence there is a major challenge to health planners.

Evidence-based advances in acute stroke have included proof of the benefit of organized care in stroke units, modern brain imaging, and thrombolytic therapy, the modest benefit of acute aspirin in ischemic stroke clearly, a lack of awareness of the common symptoms of stroke remains a major educational challenge, and the urgency of stroke treatment is still poorly appreciated. Despite the proven benefit of stroke units, the majority of patients in most countries cannot access specialized stroke care.

The article focuses on current treatment guidelines and new therapeutic prospects, emphasizing the importance of early intervention and the need for a multidisciplinary approach to the management of stroke patients.

Introduction

Stroke is a medical emergency, with a mortality rate higher than most forms of cancer. It is the second leading cause of death in developed countries and is the most common cause of serious, long-term disability in adults. The incidence of stroke is increasing with the aging of populations and hence there is a major challenge to health planners.

Evidence-based advances in acute stroke have included proof of the benefit of organized care in stroke units, modern brain imaging, and thrombolytic therapy, the modest benefit of acute aspirin in ischemic stroke clearly, a lack of awareness of the common symptoms of stroke remains a major educational challenge, and the urgency of stroke treatment is still poorly appreciated. Despite the proven benefit of stroke units, the majority of patients in most countries cannot access specialized stroke care.

The article focuses on current treatment guidelines and new therapeutic prospects, emphasizing the importance of early intervention and the need for a multidisciplinary approach to the management of stroke patients.1

Section snippets

Successful care of acute stroke patients relies on a four-step process

  • (i)

    Prompt recognition and reaction to warning signs.

  • (ii)

    Immediate use of emergency services.

  • (iii)

    Priority transport with notification of the receiving hospital and

  • (iv)

    Rapid and accurate diagnosis and intervention at the hospital. This ‘chain of recovery’ has also been described as a five-stage process, comprising the five Rs of successful stroke management: recognition (of symptoms), reaction (emergency services are called), response (medical assessment), reveal (brain imaging) and Rx (treatment initiation).1

Emergency department assessment

Once a diagnosis of acute ischemic stroke is suspected, the duration since symptom onset should be determined as accurately as possible, as time from onset is the single most important determinant of therapeutic options. Patients arriving at hospital with a symptom onset of <3–4.5 h should be evaluated for potential treatment with rt-PA, although a ‘door to needle time’ of around 60 min usually means a hospital arrival time within 2 h for rt-PA candidates.1

Every minute counts in brain stroke – “

Goals for early management of acute stroke

The goals for early management of patients with acute stroke are to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within a definitive time period of patient arrival to the hospital (Fig. 1).2, 3 Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.

The goal of these guidelines is to limit the morbidity and mortality associated with stroke.

Acute stroke program: a multidisciplinary team approach for early management of acute stroke cases at Apollo Hospitals, Hyderabad

Being an “Acute Stroke – JCI Clinical Care Program Certified Centre”, Apollo Hospitals, Hyderabad had an amplified need in timely management of acute stroke cases efficiently & effectively and thus reducing the morbidity & mortality rates, focusing on better patient outcomes.

While Time plays a chief role from arrival of the patient till discharge, and in every step starting from identification of symptoms, availability of Neuro-physician & Radiologist, emergent diagnostics & investigations (CT

Conclusion

All of the above treatment advances are based on immediate intervention, underlining the urgency of stroke recognition and early treatment. A systematic multidisciplinary protocol based acute stroke care management system, can reduce the mortality & morbidity of the patients affected with acute stroke.

Conflicts of interest

All authors have none to declare.

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    (May 2007)
  • Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals...
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