Prehospital care of acute stroke and patient selection for endovascular treatment using the RACE scale

Start Date: 01/17/2021

Course Type: Common Course

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About Course

Acute stroke is a time-dependent medical emergency. In acute ischemic stroke, the first objective is to restore brain flow using sistemic thrombolytic treatment and, in patients with large vessel occlusion, by endovascular treatment. In hemorrhagic stroke there are also specific treatments that can improve the clinical outcome. The sooner the initiation of all these therapies the higher the clinical benefit. Thus, the organization of Stroke Code systems coordinated between emergency medical systems and hospitals is crucial to achieve early medical attention and treament. Neurological scales facilitate stroke recognition at both hospital and pre-hospital levels and provide valuable information of stroke severity. The RACE scale is a prehospital scale validated as a tool to identify patients with suspected large vessel occlusion who are potential candidates for endovascular treatment. This course aims to update general knowledge in acute stroke and currently available treatments, to review the protocol of the Stroke Code and, finally, to train in the use of the RACE scale. The target profile of this course is aimed to all health professionals working in the field of emergencies.

Course Syllabus

Stroke and treatment options

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Course Introduction

Prehospital care of acute stroke and patient selection for endovascular treatment using the RACE scale A patient with ischemia or atrial fibrillation, cardiac arrest or myocardial infarction is eligible for admission to the intensive care unit (ICU). The prehospital component of the care will include assessment of the patient, initial extracapsular therapy (LVT) and/or angioplasty (AP). The patient with ischemia or atrial fibrillation, cardiac arrest or myocardial infarction will be referred to the ICU. The prehospital component of the care will include an initial physical exam, a thorough cardiac troponin analysis (CTA), evaluation of the patient in the ICU and initial extracapsular therapy (LVT). If necessary, the patient can be transported to the hospital for assessment and/or a PCI (Cardiovascular Device) or EKG (Electrocardiogram). If the patient has a known clot, he/she will be placed on a high-titer beta-blocker (Boehringer) and he will be fitted with a high-performance device (Buesch) to measure the flow of coronary plaques and coronary arteries. If the patient has a known heart attack or arrhythmia, he/she will be put on a high-performance device (Besch) and he will be fitted with a high-performance pacing machine (Boehringer) to monitor his/her heart rate, cardiac output and compliance

Course Tag

Related Wiki Topic

Article Example
Cincinnati Prehospital Stroke Scale The Cincinnati Prehospital Stroke Scale (abbreviated CPSS) is a system used to diagnose a potential stroke in a pre-hospital setting. It tests three signs for abnormal findings which may indicate that the patient is having a stroke. If any one of the three tests shows abnormal findings, the patient may be having a stroke and should be transported to a hospital as soon as possible. The CPSS was derived from the National Institutes of Health Stroke Scale developed in 1997 at the University of Cincinnati Medical Center for pre-hospital use.
Acute care Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.
Cincinnati Prehospital Stroke Scale If all 3 findings are present the probability of an acute stroke is more than 85%.
Stroke A mnemonic to remember the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, and time to call emergency services), as advocated by the Department of Health (United Kingdom) and the Stroke Association, the American Stroke Association, the National Stroke Association (US), the Los Angeles Prehospital Stroke Screen (LAPSS) and the Cincinnati Prehospital Stroke Scale (CPSS). Use of these scales is recommended by professional guidelines.
Mobile stroke unit A mobile stroke unit is an ambulance dedicated to treatment of acute stroke and similar time-sensitive brain ailments. It contains, in addition to the normal ambulance equipment, a device for brain imaging (computerized tomography), a point-of-care laboratory and telemedical interaction between ambulance and hospital (videoconferencing, exchange of videos of patient examination and CT scans). Thus, this specialized ambulance includes all the tools necessary for hyperacute treatment of stroke patients and diagnosis-based triage directly at the emergency site.
Acute care Acute care services are generally delivered by teams of health care professionals from a range of medical and surgical specialties. Acute care may require a stay in a hospital emergency department, ambulatory surgery center, urgent care centre or other short-term stay facility, along with the assistance of diagnostic services, surgery, or follow-up outpatient care in the community. Hospital-based acute inpatient care typically has the goal of discharging patients as soon as they are deemed healthy and stable. Acute care settings include but are not limited to: emergency department, intensive care, coronary care, cardiology, neonatal intensive care, and many general areas where the patient could become acutely unwell and require stabilization and transfer to another higher dependency unit for further treatment.
FAST (stroke) The FAST was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel, and an emergency room physician and was designed to be an integral part of a training package for ambulance staff. The FAST was created to expedite administration of intravenous tissue plasminogen activator to patients within 3 hours of acute stroke symptom onset. The instruments at this time with most evidence of validity were the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS).
Stroke recovery The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient’s medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.
Acute Care Nurse Practitioner The core competencies and knowledge base for the pediatric or adult-gerontology acute ACNP originate from the full spectrum of needs of high-acuity patients along the wellness-to-illness continuum. The ACNP provides individualized patient care based on the patient's age, gender, mental status, race, culture, individuality, ethnicity, spiritual beliefs, lifestyle, sexual orientation, socioeconomic status, disability, and family configuration. The type of care provided by the ACNP is determined by the needs of the patient and may include restorative, curative, rehabilitative, palliative, or supportive end-of-life care. The profile of an ACNP may include episodic management of a patient in a clinical speciality unit, following a caseload of patients during a hospitalization, or caring for patients across the acute care spectrum (hospitalization to home).
Gender differences in stroke care The use of rt-PA (Recombinant Tissue Plasminogen Activator), a protein enzyme that helps break up blood clots, is a common treatment for stroke. Research indicates that women have between 22% to 30% lower odds of receiving rt-PA treatment for acute stroke than men. When comparing the treatment of men and women with acute stroke, research has found that women are consistently less likely to receive thrombolytic (blood clot dissolving) treatments, despite findings indicating that women experiencing stroke benefit more than men from thrombolytic treatment.
Acute Care Nurse Practitioner The current procedural terminology (CPT) codes most frequently used by ACNPs are subsequent hospital visit codes (99231, 99232, and 99233) and critical care codes (99291 and 99292). The 3 main criteria for the critical care codes are (1) the condition of the patient, (2) the treatment criteria, and (3) time. The important concept when assigning a CPT code is that the intensity of the care of the patient determines the use of these codes, not where the patient is physically located.
Registry of the Canadian Stroke Network Given that the data are collected from a select group of hospitals, a significant limitation of the RCSN is that the results may not be generalizable to the entire population of patients with acute stroke. To obtain population-based stroke data, a supplemental data collection is undertaken biannually — the Ontario Stroke Audit (OSA). Using the RCSN case record form and software, the OSA collected data on a random sample of all stroke and TIA patients presenting to all acute care hospitals in Ontario. Cases are determined retrospectively using appropriate International Classification of Disease (ICD), 10th revision, Clinical Modification diagnostic codes for stroke (I60, I61, I63, I64, and G45, excluding G45.4).
National Institutes of Health Stroke Scale Since the NIHSS has been established as a quick and consistent quantifier of stroke severity, many physicians have looked to NIHSS scores as indicators for tPA treatment. This rapid assessment of stroke severity is targeted to reduce delay of tPA treatment. Some hospitals use an NIHSS of less than 5 to exclude patients from tPA treatment, however the American Heart Association urges against NIHSS scores being used as the sole reason for declaring a patient as ineligible for tPA treatment.
Los Angeles Prehospital Stroke Screen (LAPSS) The Los Angeles Prehospital Stroke Screen (LAPSS) is a method of identifying potential stroke victims in a pre-hospital setting.
Scanning Fiber Endoscope (SFE) Recent successes in acute stroke care are driving the need for every stroke center to perform endovascular reperfusion interventions. In the USA, 500,000 endovascular reperfusions interventions are performed annually.
Acute Care Nurse Practitioner The patient population of the adult gerontology acute care nurse practitioner (AGACNP) includes young adults (late adolescents and emancipated minors), adults, and older adults. AGACNP disciplines include cardiology, pulmonary, neurology, hematology/oncology, ENT, surgery services, palliative care, and pain management.
Prehospital Emergency Care The editor in chief of "Prehospital Emergency Care" is James Menegazzi (Department of Emergency Medicine, University of Pittsburgh Medical Center).
Acute Care Nurse Practitioner ACNP short-term patient care goals include stabilization of acute or life-threatening conditions, minimizing or preventing complications, and promoting physical and mental well-being. Long-term goals consist of restoring maximum health potential, evaluating risk factors, and managing co-morbid conditions. In order to achieve these goals of patient care, the ACNP utilizes the following key components:
Patient A day patient or (day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery.
Alliance for the Prudent Use of Antibiotics Wide-scale misuse of antibiotics and other antimicrobials and related resistance to these drugs is challenging infectious disease treatment and health care budgets worldwide. Antimicrobials are uniquely societal drugs because each individual patient use can propagate resistant organisms. APUA's provides information to individuals, doctors and policy makers aimed at preserving the power of these agents by preventing infection, reducing drug resistance and increasing the effectiveness of treatment for infectious diseases, including acute bacterial diseases, tuberculosis, AIDS and malaria.