2 COURSE OBJECTIVES About Stroke Stroke Policy Recommendations Stroke Protocols and Stroke Hospital Care Stroke Assessment Tools Pre-Notification Stroke Treatment
3 ABOUT STROKE
4 STROKE FACTS A stroke is a medical emergency! Stroke occurs when blood flow is either cut off or is reduced, depriving the brain of blood and oxygen Approximately 795,000 strokes occur in the US each year Stroke is the fourth leading cause of death in the US Stroke is a leading cause of adult disability On average, every 40 seconds, someone in the United States has a stroke Over 4 million stroke survivors are in the US The indirect and direct cost of stroke: $38.6 billion annually (2009) Crosses all ethnic, racial and socioeconomic groups Berry, Jarett D., et al. Heart Disease and Stroke Statistics Update: A Report from the American Heart Association. Circulation. 127, 2013.
5 DIFFERENT TYPES OF STROKE Ischemic Stroke Caused by a blockage in an artery stopping normal blood and oxygen flow to the brain 87% of strokes are ischemic There are two types of ischemic strokes: Embolism: Blood clot or plaque fragment from elsewhere in the body gets lodged in the brain Thrombosis: Blood clot formed in an artery that provides blood to the brain Berry, Jarett D., et al. Heart Disease and Stroke Statistics Update: A Report from the American Heart Association. Circulation. 127, Clots_UCM_310939_Article.jsp
6 DIFFERENT TYPES OF STROKE Hemorrhagic Stroke About 13% of strokes are caused by a hemorrhage Caused by a breakage in a blood vessel within the brain Can be the result of trauma or a ruptured aneurysm There are two types of hemorrhagic stroke: Intraparenchymal (within the brain tissue, sometimes referred to as intracerebral) Hemorrhage: A blood vessel bursts leaking blood into the brain tissue Subarachnoid Hemorrhage: Occurs when a blood vessel bursts near the surface of the brain and blood pours into the area outside of the brain, between the brain and the skull Berry, Jarett D., et al. Heart Disease and Stroke Statistics Update: A Report from the American Heart Association. Circulation. 127, Strokes-Bleeds_UCM_310940_Article.jsp
7 DIFFERENT TYPES OF STROKE Transient Ischemic Attack (TIA) A TIA or Transient Ischemic Attack produces stroke-like symptoms TIA is caused by a clot; but unlike a stroke, the blockage is temporary and usually causes no permanent damage to the brain Approximately 15% of all strokes occur after a TIA. TIA is a medical emergency!
8 STROKE RISK FACTORS Controllable Risk Factors High Blood Pressure High Cholesterol Diabetes Tobacco Use Alcohol Use Physical Inactivity Obesity Heart Disease Atrial Fibrillation Non-Controllable Risk Factors Age Gender Race Family History Previous Stroke or TIA Risk_UCM_308539_SubHomePage.jsp
9 COMMON STROKE SYMPTOMS Right Hemispheric Stroke Slurred speech - dysarthria Weakness or numbness of left face, arm or leg Left sided neglect Right gaze preference Left Hemispheric Stroke Speech problems what is being said or inability to get words out Problems with comprehension Weakness or numbness of right face, arm, or leg Left gaze preference Brainstem Stroke Symptoms Nausea, vomiting or vertigo Speech problems Swallowing problems Abnormal eye movements Decreased consciousness Crossed findings Intracerbral Hemorrhage Intraparenchymal Hemorrhage Nausea and Vomiting Headache One Sided Weakness Decreased Consciousness Subarachnoid Hemorrhage Worst Headache of Life Intolerance to Light Neck Stiffness or Pain Summers, D., Leonard, A., Wentworth, D., Saver, J. L., Simpson, J., Spilker, J. A., et al. Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient. American Heart Association, , 2009.
10 COMMON STROKE MIMICS STROKE MIMICS Alcohol Intoxication Cerebral Infections Drug Overdose/Toxicity Epidural Hematoma Hypoglycemia Metabolic Disorders Migraines Neuropathies (Bell s Palsy) Seizure and post seizure, Todd s Paralysis Brain Tumors Hypertensive Encephalopathy Summers, D., Leonard, A., Wentworth, D., Saver, J. L., Simpson, J., Spilker, J. A., et al. Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient. American Heart Association, , 2009.
11 STROKE POLICY RECOMMENDATIONS
12 EMS POLICY RECOMMENDATIONS Support ABCs: airway, breathing, circulation give oxygen if needed Perform prehospital stroke assessment Establish time when patient was last normal Rapid transport to the nearest Primary Stroke Center, Comprehensive Stroke Center or GWTG- Stroke Hospital EMS can bypass hospital without stroke resources if the stroke center is within reasonable transport range Alert receiving hospital as soon as possible of potential stroke patient CODE STROKE Check glucose level if possible
13 STROKE PROTOCOLS AND STROKE HOSPITAL CARE
14 STROKE CARE The goal of stroke care is to minimize brain injury and maximize the patient s recovery The Stroke Chain of Survival links actions to be taken by patients, family members, and healthcare providers to maximize stroke recovery. The links include: Family member, friend or bystander recognizes stroke warning signs and rapidly calls EMS rapidly arrives at scene and performs stroke assessment EMS rapidly notifies receiving hospital that patient will be arriving and EMS transports patient to the receiving hospital Hospital rapidly diagnoses and treats patient
15 HOSPITAL LEVELS OF CARE Primary Stroke Center (PSC) Stabilize and provide emergency care for patients with acute stroke Either admit or transfer to a CSC Over 1,000 PSCs to date Comprehensive Stroke Center (CSC) Have the capability to support all needed levels of care to stroke patients, including - Special interventions - Highly technical procedures 74 certified CSCs to date (began 9/2012)
16 STROKE ASSESSMENT TOOLS
17 % of Stroke Identification Sensitivity STROKE ASSESSMENT TOOLS Stroke assessment tools help EMS identify a stroke quickly and transport the individual to the appropriate center 100 EMS Stroke Identification* Pre-hospital stroke assessment training raises the accuracy of stroke identification Paramedics demonstrated a sensitivity of 61-66% without stroke assessment training and 86-97% with training Stroke Assessment Tool Training No Training in Use of Stroke Assessment Tool Training in Use of Stroke Assessment Tool Maggiore, W. A. (2012). 'Time is Brain' in Prehospital Stroke Treatment. Journal of Emergency Medical Services, 1-9.
18 FIELD ASSESSMENT OF STROKE There are multiple tools you can use to assess a stroke. Currently there are no standards set out by the AHA/ASA for the use of one Facial tool Droop: over another. Cincinnati Prehospital Stroke Scale is most widely used. The patient shows teeth Cincinnati Prehospital Stroke Scale or smiles Facial Droop Normal: Both sides of the face move equally Normal: Left and Right side of face move equally Abnormal: One side of face does not move at all Arm Drift Normal: Both left and right arm move together or not at all Abnormal: One arm does not move equally with the other Speech Abnormal: One side of the face does not move as well as the other side Normal: Patient uses correct words with no slurring Abnormal: Patient has slurred speech, uses inappropriate words or cannot speak Adapted from: Kothari RU, Pancioli A, Liu T., Brott T., Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med Apr;33(4):373-8, permission for use.
19 FIELD ASSESSMENT OF STROKE 1. Age over 45 years Los Angeles Prehospital Stroke Screen Screening Criteria Yes No 2. No prior history of seizure disorder 3. New onset of neurological symptoms in just 24 hours 4. Patient was ambulatory at baseline (prior to event) 5. Blood glucose between 60 and 400 Exam: Look for obvious Normal Right Left Facial smile/grimace Droop Droop Grip Weak grip No grip Arm Weakness Drifts down Falls rapidly Weak grip No grip Drifts down Falls rapidly Table adapted from Kidwell C.S., Starkman S., Eckstein M., Weems K., Saver J.L., Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 2000 Jan;31(1):71-6.
20 FIELD ASSESSMENT OF STROKE Miami Emergency Neurological Deficit Scale MENDS : Pre Hospital Examination Mental Status Level of Consciousness (AVPU) Speech: You can t teach an old dog new tricks Questions: (Age, Month) Commands: (Close/open eyes) Cranial Nerves Facial Droop: Show teeth or smile Visual Fields: Four Quadrants Horizontal Gaze: Side to side Limbs Motor: Arm Drift (close eyes hold out arms) Leg Drift (Open eyes lift each leg separately) Sensory: Arm, Leg (close eyes and touch, pinch) Coordination: Arm, Leg ( finger-nose, heel-shin) Adapted from Miami Miller School of Medicine, Gordon Center for Research in Medical Education
21 CONSUMER ASSESSMENT OF STROKE Face Drooping - Ask the person to smile. Does one side of the face droop or is it numb? Arm Weakness - Ask the person to raise both arms. Is one arm weak or numb? Does one arm drift downward? Speech Difficulty - Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly? Are they unable to speak, or are they hard to understand? Time to call If the person shows any of these symptoms, even if the symptoms go away, call and get them to the hospital immediately.
23 PRE-NOTIFICATION SYSTEMS EMS professionals can notify hospital staff that a stroke patient is being sent to the hospital prior to them arriving at the hospital Pre-notification systems help improve rapid triage, evaluation, and treatment of patients with acute ischemic stroke The sooner the patient gets to medical treatment, the greater potential for a better outcome EMS Pre-Notification Systems The study cited below by Lin, et al. observed shorter symptom onset to hospital arrival when a pre-notification system was used There was an increase in the amount of patients with door-toimaging times within 25 min When a prenotification system was used there were lower onset to door times observed (113 min vs. 150 min) Overall, prenotification resulted in more rapid triage, evaluation, and treatment of patients with acute ischemic stroke Lin, C. B., Peterson, et al. (2012). Emergency Medical Service Hospital Pre-Notification is Associated with Improved Evaluation and Treatment of Acute Ischemic Stroke. Journal of the American Heart Association, 1-9.
24 TRAINING TOOLS OnlineAHA.org ACUTE STROKE ONLINE Course Content - Stroke chain of survival - Definitions of stroke types - Pathophysiology - Stroke risk factors, recognition, management - Transition to critical care and rehabilitation Intended Audience The experienced healthcare provider who wants to improve his or her knowledge of stroke treatment CME ACCME/AMA (Physicians) ANCC (Nurses) CECBEMS (EMS Practitioners) STROKE PREHOSPITAL CARE ONLINE Course Content - Pathophysiology - Risk factors - Differential diagnosis - Recognition - Assessment - Management EMS Personnel Intended Audience CME CECBEMS (EMS Practicioners)
25 STROKE TREATMENT OPTIONS
26 STROKE TREATMENT PROTOCOLS Patient Arrives at Comprehensive Stroke Center ER Symptom onset < 3 hrs (4.5 hours) TPA Eligible YES TPA Eligible No CT/MR Imaging Start IV TPA CTP/CTA/MRP/ MRA Consider Other Interventional Treatments Symptom onset > 3 hrs (4.5 hours)m onset > 3 hours Stroke Protocol Map Covidien Part Number (A) JUN/12
27 STROKE TREATMENT OPTIONS Medical Management IV-tPA is the clot busting drug used with stroke patients Patients must be within the time window of 0-3 (or hour window (in certain eligible patients) hours from symptom onset There are other contraindications associated with the use of the drug Intra-arterial Thrombolysis IA thrombolysis is a technique where the doctor uses a catheter (like a heart catherization) to administer tpa directly into the blood clot blocking blood flow to part of the brain This treatment can be administered up to 6 hours after stroke symptoms onset Patients must meet strict criteria in order to receive this procedure Mechanical Thrombectomy This procedure uses a device to retrieve the clot The time window for mechanical thrombectomy is up to 8 hours from symptom onset If the patient fails IV-tPA or is ineligible for IV-tPA, they may be eligible for mechanical thrombectomy
28 PUBLISHED RCT CURRENT TREATMENT OUTCOMES Thrombolytics Revascularization success with IV rt-pa Mortality rates Disability (Modified Rankin Scale measure of disability at 90 days after rt-pa) Mechanical Thrombectomy Revascularization success with endovascular/interventional procedures Mortality rates Disability (Modified Rankin Scale measure of disability at 90 days after an interventional procedure) Tissue Plasminogen Activator for Acute Ischemic Stroke. The New England Journal of Medicine, 333:24, Mendes, Dávalos A, Pereira V, Chapot R, Bonafé A, Andersson T, and Jan, Gralla. Retrospective Multicenter Study of Solitaire FR for Revascularization in the Treatment of Acute Ischemic Stroke. Stroke Pereira, Vitor M., et al. Prospective, Multicenter, Single-Arm Study of Mechanical Thrombectomy Using Solitaire Flow Restoration in Acute Ischemic Stroke. Stroke Saver, Jeffrey L., et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised,parallel-group, non-inferiority trial. The Lancet
Developing a Dynamic Team Approach to Stroke Care Emergency Medical Services 2015 Why Stroke, Why now? A recent study showed that 80 percent of people in the United States live within an hour s drive of
JHS Stroke Program 2016 JHS Annual Mandatory Education Learner Objectives At the conclusion of this module learners will be able to: State the definition of stroke Discuss the pathophysiology of stroke
EMERGENCY STROKE TREATMENT Robert Flint, M.D., Ph.D. INDIANA EPIDEMIOLOGY 7 th highest stoke rate in the country 18 th in mortality from stroke 2% of Indiana population living with sequelae of stroke Cost
IS EMS A PART OF YOUR STROKE TEAM? S. R. Scott, MD Chief of Service Associate EMS Medical Director Department of Emergency Medicine New Jersey Medical School-Newark Presenter Disclosure Information Sandra
Explaining Stroke Introduction Explaining Stroke is a practical step-by-step booklet that explains how a stroke happens, different types of stroke and how to prevent a stroke. Many people think a stroke
What Is a Stroke? From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D., Chair 1 What Is a Stroke? From
Complex Stroke Cases and Barriers in PSC and CSC June 14, 2013 Wisconsin Coverdell Stroke Program Marc A. Lazzaro, MD Assistant Professor of Neurology and Neurosurgery Interventional and Vascular Neurology
BACKGROUND Intracranial hemorrhage, a type of stroke, is bleeding in the brain from a broken blood vessel. It represents 10-20% of all strokes, effects over 45,000 Americans per year and has a 2/3 mortality
What You Should Know About Cerebral Aneurysms From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D.,
Let s talk about: Stroke February 20 th 2013 Laura Wilson Christine Stables Questions 1. Why is knowing about stroke important? 2. What exactly is a stroke and what are the symptoms? 3. What should I do
Note to Teachers about The Virtual Stroke Lab Student Handout This document contains a handout that can be distributed for students to fill out as they complete The Virtual Stroke Lab, a free online Virtual
PAST MEDICAL HISTORY History and/or clinical examination which clearly defines the new onset of focal or global neurological deficit. Date and time of onset of symptoms: Did symptoms resolve? [Y] Yes [N]
canadian stroke network A Patient s Guide to Canadian Best Practice Recommendations for Stroke Care Canadian Best Practice Recommendations for Stroke Care have been developed by stroke experts across the
Slumping, Slurring and Slipping Away: Stroke Assessment Laurie A. Romig, MD, FACEP Medical Director Pinellas County (FL) EMS Caution! This discussion relates only to nontraumatic neurological problems!
What is a stroke? What is a stroke? Basic information about stroke and how it can affect you We re for life after stroke Need to talk? Call our confidential Stroke Helpline on 0303 3033 100. You may also
2016 Research Paper: Stroke STEP NUS SUNBURST BRAIN CAMP NG XIN NI, XIE JIAYING, YEE TING HUI, ZHANG QING YANG RIVER VALLEY HIGH SCHOOL Contents 1. INTRODUCTION... 2 1.1. IMPORTANCE OF UNDERSTANDING STROKE...
P A T I E N T V E R S I O N The Prevent Defense Against Stroke: Preventing a Second Stroke or Transient Ischemic Attack Sponsored by Support for this activity has been provided through an educational grant
Hemorrhagic Stroke GENERAL INFORMATION: What is a hemorrhagic stroke? A hemorrhagic stroke happens when a blood vessel in the brain bursts. This may happen if the blood vessel wall is weak, or sometimes
Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced
ACCESS CENTER: 1-877-367-8855 Emergency Specialty Services: BRAIN ATTACK Criteria: Stroke symptom onset time less than 6 hours Referring Emergency Department Patient Information Data: Time last known normal:
WMAS Clinical Guidelines CLN PRO - 027 I Version - 4 Guideline ID CLN PRO - 027 Version Version 4 Title WMAS Stroke Guidelines Approved by Clinical Steering Group Date Issued 4 May 2016 Review Date May
Ward:: Subject: Neurology? Een beroerte en dan? 1 The brain and its function The brain and the spinal cord together form the central nervous system. This system compares well to a telephone exchange. Through
1 REGIONAL STROKE TRIAGE PLAN Rappahannock EMS Council 435 Hunter Street Fredericksburg, VA 22401 Phone: (540) 373-0249 Fax: (540) 373-0249 E-mail: firstname.lastname@example.org www.rems.vaems.org Approved by Board of
UNDERSTANDING YOUR STROKE Ischemic / TIA MIND BODY SPIRIT EMOTION Stroke: Mind, Body, Spirit, Emotions What is a Stroke? A stroke is a sudden decrease in the oxygen and blood supply to part of the brain.
UNDERSTANDING STROKE DUE TO INTRACEREBRAL HAEMORRHAGE This factsheet provides information for people who have had a stroke due to an intracerebral (bleed in the brain) and for their families and carers.
Types of Brain Injury The bones of your skull are hard and they protect your brain. Your brain is soft, like firm Jell-O. When your head moves, your brain moves inside your skull. When your head is hit
1 Use of the NIH Scale (NIHSS) in Emergency Department Patients with Acute Professor Department of Emergency Medicine University of Illinois College of Medicine Chicago, IL Global Objectives Improve pt
Key Primary Care Secondary Care Transient Ischemic Attack (TIA) Diagnostic Pathway Patient presents to GP or A&E with Acute Neurological symptoms Click on the hyperlinks in the pathway to access the supporting
A Patient s Guide to Canadian Best Practice Recommendations for Stroke Care Canadian Best Practice Recommendations for Stroke Care have been developed by stroke experts across the country. These recommendations
Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE What is atrial fibrillation? Atrial fibrillation
4th Annual New York Stroke Conference Maximizing Stroke Quality of Care: Key Ingredients Thomas Kwiatkowski, MD Medical Director : Center for Emergency Medical Services NSLIJ No relevant financial relationships
S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration
Stroke Systems of Care Ashutosh P. Jadhav, MD PhD Assistant Professor, Neurology and Neurological Surgery Center for Neuro-endovascular Therapy UPMC Stroke Institute Pittsburgh, PA Stroke chain of survival
King County EMS Stroke Quality Improvement Program A Report from the King County EMS Medical QI Section March 2012 Prepared by Sofia Husain, Jim Duren, and Norm Nedell OBJECTIVE The goal of the King County
Diabetes and Stroke Understanding the connection between diabetes and the increased risk of stroke Make the Connection Almost 26 million people in the U.S. roughly 8 percent of the population have diabetes.
Understanding NICE guidance Information for people who use NHS services Early assessment and treatment of people who have had a stroke or transient ischaemic attack (TIA) NICE clinical guidelines advise
What Is an Arteriovenous Malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall T. Higashida, M.D., Chair 1 What
Heart disease Heart disease may include a number of heart conditions or problems, such as angina, heart failure or abnormal heart rhythms. If you think that you may have a heart problem, you should speak
Fainting - Syncope Introduction Fainting, also known as syncope, is a temporary loss of consciousness. It is caused by a drop in blood flow to the brain. You may feel dizzy, lightheaded or nauseous before
OHSU HEALTH CARE SYSTEM PRACTICE STANDARD Acute Stroke Practice Standard for the Emergency Department (includes ischemic stroke, TIAs, intracerebral hemorrhage, and non-subarachnoid hemorrhage), PS 01.11
DIAGNOSTIC CRITERIA OF STROKE Diagnostic criteria are used to validate clinical diagnoses. Here below MONICA diagnostic criteria are reported. MONICA - MONItoring trends and determinants of CArdiovascular
Canadian Stroke Strategy Core Performance Indicator Update 2010 Developed by: CSS Information & Evaluation Working Group June 2010 Table One: CSS Core Indicators Set 2010 (Based on Consensus Review Panel
Therapeutic Management Options for Acute Ischemic Stroke Anna Rosenbaum, MD Epidemiology Epidemiology 4 th leading cause of death in the United States 1 Leading cause of disability Increase in projected
ALBERTA PROVINCIAL STROKE STRATEGY (APSS) Stroke Systems of Care Key Components APSS Pillar Recommendations March 28, 2007 1 The following is a summary of the key components and APSS Pillar recommendations
STROKE INTRODUCTION Stroke is the medical term for a specific type of neurological event that causes damage to the brain. A commonly used term for stroke is cerebrovascular accident, typically shortened
TIME LOST IS BRAIN LOST. TARGET: STROKE CAMPAIGN MANUAL 2010, American Heart Association TARGET: STROKE CAMPAIGN MANUAL 01 INTRODUCTION Welcome to the Target: Stroke. The purpose of this manual is to provide
BRAIN AND SPINAL CORD INJURIES INTRODUCTION Brain and spinal cord injuries are very common medical emergencies. Brain injuries associated with medical conditions are the third leading cause of death in
Emergency Department Discharge Toolkit For Patients with Atrial Fibrillation Stroke Risk for Patients with Atrial Fibrillation: For Patients Sponsored by Boehringer Ingelheim Pharmaceuticals, Inc. Stroke
EMS Management of Stroke Deaver Shattuck, M.D. Brian Wiseman, M.D. Keith Woodward, M.D. Financial Disclosure: No relevant financial relationship exists Working Together to End Stroke Formed in 2013 Identified
The Savvy PSC: Review of the 2014 Primary Stroke Certification Standards Wendi J. Roberts RN, BA, MS, TNS, CLNC Field Director, Surveyor Management and Development Division of Accreditation and Certification
What is a? A happens when the blood supply to the brain is interrupted. Blood contains oxygen and important nutrients for your brain cells. Blood may stop moving through an artery because it is blocked
AHA/ASA Guideline Guidelines for the Early Management of Adults With Ischemic Stroke A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council,
GP workshop Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre Stroke: the Facts Stroke: the Facts Every 5 minutes someone in the UK has a stroke 1 in 4 men and 1 in 5 women will have a stroke
The Vascular Surgery team at the University of Michigan is dedicated to providing exceptional treatments for in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical facility. Treatment
Atrial Fibrillation What to Know About Atrial Fibrillation Understanding Afib Atrial fibrillation, or Afib, is a condition in which the heart beats irregularly speeding up or slowing down, or beating too
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Bleeding in the brain haemorrhagic stroke Most strokes are caused by a blockage in an artery leading to the brain an ischaemic stroke. However, about
Listen to Your Heart The S-ICD System What Everyone Needs To Know About Atrial Fibrillation & Stroke The protection you need without Stroke. touching Are you your at heart risk? Increase your knowledge.
STROKE SYNDROMES: RAPID RECOGNITION & TRIAGE David Lee Gordon, M.D., FAAN, FANA, FAHA Professor and Chair Department of Neurology The University of Oklahoma Health Sciences Center STROKE SYNDROMES: RAPID
A WorkLife4You Guide Heart Attack: What You Need to Know What is a Heart Attack? The heart works 24 hours a day, pumping oxygen and nutrient-rich blood to the body. Blood is supplied to the heart through
Who? Level III Stroke Center Data Collection Requirements All LERN Level III Stroke Centers. LERN Level I and II Stroke Centers have reporting requirements to The Joint Commission or other Board approved
Vision Health: Conditions, Disorders & Treatments NEUROOPTHALMOLOGY Neuroophthalmology focuses on conditions caused by brain or systemic abnormalities that result in visual disturbances, among other symptoms.
Treatment for Carotid Artery Disease: Carotid Endarterectomy and Stenting There are 4 arteries in your neck. They supply blood to your brain. They are the right and left internal carotid arteries and the
Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of
this booklet is provided for for any non emergency questions, contact us at Aneurysm Embolization System for the Treatment of Cerebral Aneurysms Information for Patients and Families 2 3 Information for
CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE Philip C. Henry, Esquire Henry, Spiegel, Fried & Milling, LLP Suite 2450 950 East Paces Ferry Road Atlanta, Georgia 30326
Basic Stroke for the New Recruit Authors Erin Conahan MSN, RN, ACNS-BC, CNRN, SCRN Julie FussnerBSN, RN, CPHQ, SCRN The authors have nothing to disclose. 1 Objectives List causes of small vessel stroke
STROKE SERIES SS10 Understanding thrombolysis treatment For stroke Chest Heart & Stroke Scotland improves the quality of life for people in Scotland affected by chest, heart and stroke illness, through
CLINICAL ASSESSMENT OF STROKE: AREVIEW FOR ED NURSES Authors: Karen Bergman, RN, PhDc, Dean Kindler, MD, and Lindsy Pfau, RN, Kalamazoo, MI Stroke affects approximately 795,000 persons in the United States
Carotid Artery Disease Circulating the Facts About Peripheral Vascular Disease Brought to you by the Education Committee of the Society for Vascular Nursing 1 www.svnnet.org Carotid Artery Disease This
BLS- Healthcare Provider Review Packet Updated for 2010 ECC/CPR Guidelines Revised August 2011 Purpose of CPR (cardiopulmonary resuscitation) = Circulate oxygenated blood to the vital organs Purpose of
1st Global Conference on Healthy Lifestyles and Noncommunicable Diseases Control Moscow, 28-29 April, 2011 The International Agenda for Stroke Marc Fisher MD, University of Massachusetts Editor-in-Chief,
What is The Relationship Between Migraine and Stroke? Neurologist Gives His Thoughts. Migraine and Stroke: Two Peas in a Very Dangerous Pod Migraine and stroke are very common and debilitating neurological
Fitness after stroke Dr Sarah Moore and Simon Clark - May 2016 Newcastle University, 2014. Do not copy without permission Stroke facts Stroke occurs approximately 152,000 times a year in the UK; that is
www.irishheart.ie www.stroke.ie WHAT IS A STROKE AND HOW TO TREAT STROKE One in five people have a stroke at some time in their life. Stroke can strike at any age. It could happen to you, a friend or family
When a stroke happens When a stroke happens What to expect during the first hours, days and weeks after a stroke We re for life after stroke Introduction Need to talk? Call our confidential Stroke Helpline
Taking Charge of Your Stroke Recovery A SURVIVOR'S GUIDE TO THE CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS BE INFORMED BE INVOLVED TAKE ACTION BE INFORMED BE INVOLVED TAKE ACTION The Canadian Stroke
Stroke Care First week Florence Nightingale (1820 1910) Stroke Unit Dedicated personnel trained in stroke management Stepwise guidelines supported by explicit checklists Continuous monitoring available
A Collaborative Effort to Improve Emergency Stroke Care: Mobile Stroke Unit What can we do to cut down the time it takes to give a clot dissolving drug (tpa)? MOBILE STROKE UNIT! Mobile Stroke Unit Mobile
ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Alteplase (Tissue Plasminogen Activator (t-pa)), Activase in the Treatment
Case report A 82-year-old man was suffered from sudden onset spasm of extremities then he fell down to the ground with loss of consciousness. He recovered his consciousness 7-8 mins later but his conscious
Original Article http://dx.doi.org/10.3349/ymj.2014.55.1.25 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 55(1):25-29, 2014 Development of Smartphone Application That Aids Stroke Screening and Identifying
When Minutes Matter: OPTIMIZING ACCESS TO HEALTH CARE Vicky Tam- Project Manager/GIS Analyst Karl Dailey - Database Analyst ESRI User Conference, 2015 Cartographic Modeling Lab University of Pennsylvania