Public education in the signs and symptoms of stroke is vital.
Asystematic review of the literature was performed by a multidisciplinary American Heart Association panel to document current, comprehensive guidelines for the management of ischemic stroke in the first 48 hours of the event. The resultant report is divided into sections concerning prehospital care, emergency evaluation and diagnosis, preadmission general supportive care and treatment of acute complications, general acute treatment after admission to the hospital, and treatment of acute neurologic complications.
An estimated 19% to 60% of stroke patients present for initial medical care within three hours of the onset of symptoms-14% to 32% of those within two hours. The immediate use of emergency medical services is recommended upon recognition of the onset of symptoms to minimize the interval preceding initial physical and neurologic examination and the performance of brain imaging. Thus educating the public on the early signs and symptoms of stroke is encouraged.
The report also encourages the establishment and proliferation of "primary" or "comprehensive" stroke centers to facilitate the organization and delivery of care upon arrival at the hospital-the use of lytic agents, which have been associated with better care and outcomes, is greater in such facilities. The report recommends, in the absence of a stroke center, the development of acute stroke teams in the ED that function according to a protocol that expedites clinical assessment, diagnostic study, and decisions concerning early management and treatment within 60 minutes of the patient's arrival. Evaluation of brain imaging (computed tomography or magnetic resonance imaging) scans by an appropriately skilled physician should be performed prior to the initiation of any treatment therapy. Recommendations for general supportive care in the acute management of stroke are based on limited data, but the support of vital functions is the cornerstone of treatment in the first 48 hours. Urgent anticoagulation is not recommended in the treatment of patients with acute ischemic stroke.
Neurologic worsening occurs in about 25% of patients within the first 24 to 48 hours of a stroke, and close observation, especially during that period, is vital. Acute neurologic complications in ischemic stroke include seizure and brain edema, the latter of which is a principal cause of death for which no medical or surgical interventions have been established as effective. Also, some patients with acute ischemic stroke sustain fatal brain injury that leaves them in a persistent vegetative state. It is therefore important that nurses talk with the family about any advance directives that might be in place, or about medical power of attorney in the absence of advance directives, to ensure that the patient receives only the desired interventions and that the family's intentions are supported during the end-of-life period.
The crux of the matter. Because ischemic stroke is an emergent event demanding response and the initiation of treatment as quickly as possible, public education in the signs and symptoms associated with stroke is vital to the initiation of urgent care and prompt arrival at the hospital.