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ACUTE STROKE

Outcomes for patients with stroke have improved significantly due to the implementation of Acute Stroke Systems of Care. The community is better equipped to recognize stroke as a "brain attack" and there is greater awareness of the importance of medical care within one hour of symptom onset. Likewise, EMS systems have been enhanced to transport patients to regional stroke care centers that are equipped to administer fibrinolytics.

STROKE CHAIN OF SURVIVAL

stroke chain of survival

GOALS OF ACUTE ISCHEMIC STROKE CARE

The overall goal of stroke care is to minimize brain injury and optimize the patient’s recovery. Preferential transport to stroke-capable centers has been shown to improve outcomes. Stroke centers are equipped with resources often not available at smaller community hospitals. The presence of specialists, including neurologists and stroke care specialists, multidisciplinary teams experienced in stroke care, advanced imaging modalities and other therapeutic options make transport to stroke centers the most suitable option. The goal of the stroke team, emergency physician, or other experts should be to assess the patient with suspected stroke within 10 minutes of

THE 8 D'S OF STROKE CARE

DETECTION Rapid recognition of stroke systems
DISPATCH Early activation and dispatch of EMS by 911
DELIVERY Rapid EMS identification, management, and transport
DOOR Transport to stroke center
DATA Rapid triage, evaluation, and management in ED
DECISION Stroke expertise and therapy selection
DRUG Fibrinolytic therapy, intra-arterial strategies
DISPOSITION Rapid admission to the stroke unit or critical care unit
The 8 D's of Stroke Care highlight the major steps of diagnosis and treatment of stroke and key points at which delays can occur.