Get certified in ACLS Recertification for just $175.00.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
So now let’s take a look at the major types of strokes of which we should be familiar. The word stroke is a general term and refers to an acute neurologic impairment following interruption of blood supply to a specific area of tissue within the brain. Although immediate stroke care is vital for every patient, the point of this education is about reperfusion therapy for acute ischemic stroke. Now there are two major types of stroke that we want to talk about. They are ischemic stroke which accounts for almost 87% of all strokes and is usually caused by an embolism which occludes an artery and affects the subsequent tissue of the brain that that particular artery affected. The second is called hemorrhagic stroke. Now this type accounts for close to 13% of the rest of strokes and occurs when a blood vessel in the brain ruptures and bleeds into the surrounding tissue causing damage. In the cases of suspected or confirmed hemorrhagic stroke, fibrinolytic therapy is contraindicated and the use of anticoagulants is to be avoided. Can you believe that about 795,000 people have a new or recurrent stroke each year in the United States? Well that’s why stroke remains a leading cause of death in the United States. And it’s important to realize that early recognition and treatment of acute ischemic stroke is important because IV fibrinolytic treatment should be provided as soon as possible. So over the years, there has been significant improvements in stroke care because of a combined effort between public education, 911 dispatch, detection by EMS and triage, systematic hospital stroke protocol, and bettered management of stroke units. Now there has been an increase of appropriate fibrinolytic therapy and the overall stroke care has definitely improved. And in many cases, ACLS providers are well within the scope of being qualified to identify and manage the initial care of patients displaying acute stroke symptoms. In stroke cases, it’s important to recognize that an ECG though helpful, should not take priority over obtaining a computed tomography known commonly as the CT scan. Remember, there is no one arrhythmia specific for or related to stroke, but an ECG may help identify some evidence of a recent acute MI or arrhythmia such as atrial fibrillation which could have been the cause of an embolic type stroke. Many stroke patients demonstrate arrhythmias, but if the patients hemodynamically stable, treatment of such arrhythmias are not usually indicated. It’s generally accepted and recommended to initiate and maintain cardiac monitoring during the first 24 hours of observation in patients who have experienced acute ischemic stroke in order to detect atrial fibrillation and other potentially life-threatening arrhythmias. This is important because the goal of stroke care is to minimize brain injury and maximize recovery. You see the American Heart Association and the American Stroke Association have developed the Stroke Chain of Survival and is similar to the Chain of Survival for sudden cardiac arrest. It correlates actions to be taken by patients, family members, and healthcare providers in order to maximize stroke recovery. The following are established links. The first link: rapid recognition and reaction to stroke warning signs. The second link: rapid EMS dispatch. The third link: rapid EMS system transport and pre-arrival notification to the receiving hospital by the EMTs. The fourth: rapid diagnosis and treatment upon arrival to the appropriate hospital. Patients with acute ischemic stroke have what is referred to as “time-dependent benefit” for fibrinolytic therapy which is similar to patients with an MI that demonstrates ST-segment elevation, but in the case of stroke, this time-dependent benefit is much shorter. It’s important to remember that the critical time period for administration of IV fibrinolytic therapies begins with the onset of symptoms. Critical time periods from hospital arrival are summarized now: Immediate general assessment should be 10 minutes, immediate neurologic assessment performed within 25 minutes. Acquisition of CT scan of the head is to be within 25 minutes while interpretation of the CT scan is completed within 45 minutes. Administration of fibrinolytic therapy, within 60 minutes from the time of Emergency Department arrival. And keep in mind that the administration of fibrinolytic therapy may be delivered in as much as 3 to 4.5 hours in some select patients timed from onset of their symptoms. The administration of endovascular therapy should be 6 hours in selected patients timed from onset of symptoms. And lastly, admission to a monitored bed should be within 3 hours.
In this lesson, we're going to look at the major types of stroke of which you should be familiar. But first, the word stroke is a general term that refers to an acute neurological impairment following an interruption in blood supply to a specific area of tissue within the brain.
Although immediate stroke care is vital for every patient, the point of this particular lesson is about reperfusion therapy for acute ischemic stroke.
There are two major types of stroke:
Warning: In cases of suspected or confirmed hemorrhagic stroke, fibrinolytic therapy is contraindicated, and the use of anticoagulants is to be avoided.
Around 795,000 people have a new or recurrent stroke each year in the U.S., which is why stroke remains a leading cause of death in the U.S.
Pro Tip #1: It's important to realize that early recognition and treatment of acute ischemic stroke is vital because IV fibrinolytic treatment should be provided as quickly as possible.
Over the years, there have been significant improvements in stroke care because of the combined efforts between public education, 911 dispatch, early detection by EMS and triage, systematic hospital stroke protocol, and better overall management of stroke units.
There has also been an increase in appropriate fibrinolytic therapies and overall stoke care has definitely improved. In many cases, ACLS providers are well within the scope of being qualified to identify and manage the initial care of patients who are displaying acute stroke symptoms.
In stroke cases, it's important to recognize that while an ECG is helpful, it should not take priority over obtaining a computed tomography, known commonly as a CT scan.
Pro Tip #2: It's also important to remember that no one arrhythmia is specific for or related to stroke. However, an ECG may help identify some evidence of a recent acute myocardial infarction or an arrhythmia such as atrial fibrillation, which could have caused that embolic stroke.
Many stroke patients demonstrate arrhythmias, but if the patient is hemodynamically stable, treatment of such arrhythmias are not usually indicated.
It is generally accepted and recommended to initiate and maintain cardiac monitoring during the first 24 hours of observation in patients who have experienced an acute ischemic stroke in order to detect atrial fibrillation and other potentially life-threatening arrhythmias. This is important because the goal of stroke care is to minimize brain injury and maximize recovery.
The American Heart Association and the American Stroke Association have developed a stroke chain of survival that is similar to the chain of survival for sudden cardiac arrest.
The stroke chain of survival correlates actions to be taken by patients, family members, and healthcare providers in order to maximize stroke recovery.
The established links in the stroke chain of survival are as follows:
Patients with acute ischemic stroke have what is referred to as time-dependent benefit for fibrinolytic therapies, which is similar to patients with a myocardial infarction that demonstrates ST-segment elevation. However, in stroke cases, this time-dependent benefit is much shorter.
Pro Tip #3: It's important to remember that the critical time period for the administration of IV fibrinolytic therapies begins with the onset of symptoms.
The critical time periods from hospital arrival are as follows: