Out-of hospital and in hospital stroke care

Rezumat

Recent data indicate that 29-65% of patients with signs or symptoms of acute stroke access their initial medical via local EMS which confi rm the role of EMS in the chain of survival. The creation of stroke centers with the personnel programs expertise and infrastructure to cave for many patients with strokes, uses many acute therapies (such as intravenous rtPA) and admit such patients into a stroke unit. Stroke unit is designed to care for patients with complicated typs of strokes, patients with intracerebral hemorrhage or Ştiinţe Medicale 263 subarachnoid hemorrhage, and those requiring specific interventions (surgery or endovascular procedures) or an intensive cave. An organized protocol for the emergency evaluation of patients with strokes, designation of an acute stroke team that includes physicians, nurses and laboratory/ radiology personnel is recommended. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke. Intra-arterial thrombolysis is an option for treatment of selected patients who have major stroke of < 6 hours duration due to occlusions of the MCA and who ave not candidates for intravenous rtPA. The management of patients after admission to the hospital remains a key component of overall treatment and it is as important as the acutely administered therapies. These therapies can improve outcomes by lessening complications and speeding recovery from stroke.