Four Evolving Strategies In The Emergent Treatment Of Acute Ischemic Stroke - $30.00
July 2012 (Volume 14, Number 7)
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAFP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
R. Jason Thurman, MD, FAAEM
Associate Professor of Emergency Medicine, Associate Director, Residency Program, Director of Quality and Patient Safety, Department of Emergency Medicine, Associate Director, VUMC Stroke Center, Vanderbilt University Medical Center, Nashville, TN
Edward C. Jauch, MD, MS, FAHA, FACEP
Professor, Department of Neurosciences, Associate Vice Chair, Research, Department of Medicine, Professor and Director, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC
Peter D. Panagos, MD, FAHA, FACEP
Associate Professor, Department of Emergency Medicine and Neurology, Washington University School of Medicine, St. Louis, MO
Matthew R. Reynolds, MD, PhD
Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
J Mocco, MD, MS, FAANS, FAHA
Associate Professor of Neurological Surgery, Radiology, and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
Andrew Asimos, MD
Director of Emergency Stroke Care, Carolinas Medical Center, Charlotte, NC
Joshua S. Broder, MD, FACEP
Associate Professor, Residency Program Director, Division of Emergency Medicine, Duke University Medical Center, Durham, NC
Christopher Lewandowski, MD
Residency Program Director, Vice Chair, Department of Emergency Medicine, Henry Ford Hospital; Clinical Professor of Emergency Medicine, Wayne State University, Detroit, MI
Stroke is the leading cause of long-term disability in the United States and is the fourth leading cause of death, affecting nearly 800,000 patients each year. The physical, emotional, and financial toll stroke inflicts on patients and their families cannot be overstated. At the forefront of acute stroke care, emergency clinicians are positioned to have a major impact on the quality of care that stroke patients receive. This issue outlines and reviews the literature on 4 evolving strategies reflecting developing advancements in the care of acute ischemic stroke and their potential to impact patients in the emergency department setting: (1) the expanding window for intravenous rt-PA, (2) the use of multimodal computed tomographic scanning in emergent diagnostic imaging, (3) endovascular therapies for stroke, and (4) stroke systems of care. Whether practicing in a tertiary care environment or in a remote emergency department, emergency clinicians will benefit from familiarizing themselves with these advancements and should consider how these new approaches might influence their management of patients with acute ischemic stroke.
Excerpt from issue
A 64-year-old male presents to the ED with the acute onset of profound right-sided motor weakness and expressive aphasia. The patient has no headache, no history of trauma, and no other problems upon presentation. His only chronic medical problem is hypertension that is well controlled on his medications. His wife witnessed the onset of his symptoms while they were eating dinner 3.5 hours prior to arrival. He has normal vital signs, and a stat CT scan of the head is normal as are his laboratory studies. His deficits have persisted throughout his expedited workup and he is now 4 hours into an acute ischemic stroke (an hour beyond the FDA-approved treatment window for intravenous rt-PA), with a calculated NIHSS score of 16. What emergent treatment options, if any, do you have for this patient?