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Complications of Fibrinolytics ·          Symptomatic intracranial hemorrhage ·          Orolingual angioedema (1.5%) ·          Acute hypotension ·          Systemic bleeding Note:   Symptomatic intracranial hemorrhage occurred in 6.4% of the 312 patients treated in the NINDS trials and 4.6% of the 1135 patients treated in 60 Canadian centers Fibrinolytic Precautions ·          Care dose calculation ·          Removal of excess medication ·          Holding anticoagulants and anitplatelet medications for 24 hours until repeat CT scan shows no hemorrhage Note:   Removal of excess rtPA help prevent inadvertent administration of excess rtPA General Stroke Care ·      ...

CT Scan ·          Should be completed within 25 minutes of the patient's arrival ·          Should be interpreted within 45 minutes of ED arrival ·          More advanced neurologic imaging should not delay initiation of IV rtPA ·          During the first few hours noncontrast CT scan may not indicate signs of brain ischemia ·          If negative for intracerebral hemorrhage, the patient may be a candidate for fibrinolytic therapy Fibrinolytics Inclusion Criteria ·          Diagnosis of ischemic stroke causing measurable neurologic deficit ·          Onset of symptoms <3 hours before beginning treatment ·          Age ≥18 years Fibrinolytics Exclusion Criteria ...

Critical EMS Assessments ·          Support ABCs: O 2 for oxygen saturation <94% ·          Perform CPSS assessment ·          Establish time of onset of symptoms ·          Triage to stoke center ·          Alert hospital ·          Check glucose Note:   If the patient wakes from sleep or is found with symptoms of a stroke, the time of onset of symptoms is defined as the last time the patient was observed to be normal. Unless the patient is hypotensive (systolic blood pressure <90 mm Hg), prehospital intervention for blood pressure is not recommended EMS systems should establish a stroke destination preplan to enable EMS providers to direct patients with acute stroke to appropriate facilities Circulation. 2010; 122: S818-S828 doi: 10.1161/​...

Warning Signs and Symptoms of Possible Stoke ·          Sudden onset of weakness ·          Sudden confusion ·          Trouble speaking or understanding ·          Sudden trouble seeing in one or both eyes ·          Sudden trouble walking ·          Dizziness or loss of balance or coordination ·          Sudden severe headache with no known cause Note :   Identifying clinical signs of possible stroke is important because recanalization strategies (intravenous [IV] fibrinolysis and intra-arterial/catheter-based approaches) must be provided within the first few hours from onset of symptoms Public Education ·          Public must be educated regarding the signs an...

Overall Goal of Stoke Care ·          Minimize brain injury ·          Maximize the patient’s recovery Demographics ·          Male to female ratio 1.25:1 for ages 55-64 ·          Male to female ratio 1.50:1 for ages 65-74 ·          Male to female ratio 1.07:1 for ages 75-84 ·          Blacks have almost twice the risk of a first stroke than whites ·          In the US about 795,000 people suffer an new or recurrent stroke ·          Stokes are the leading cause of death in the US Stoke Facts ·          87% of strokes are ischemic ·          13% hemorrhagic (10% intracerebral and 3% su...