Part 11: Adult Stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Abstract

N early 15 years of increased stroke education and orga- nization has produced significant strides in public awareness and development of stroke systems of care.Despite these successes, though, each year 795 000 people suffer a new or repeat stroke, and stroke remains the third leading cause of death in the United States. 1 Many advances have been made in stroke prevention, treatment, and rehabilitation, but arguably the greatest gains have been in the area of stroke systems of care.Integrating public education, 911 dispatch, prehospital detection and triage, hospital stroke system development, and stroke unit management have led to significant improvements in stroke care.Not only have the rates of appropriate fibrinolytic therapy increased over the past 5 years, but also overall stroke care has improved, in part through the creation of stroke centers. 2 To achieve further improvement in reducing the burden of stroke, healthcare providers, hospitals, and communities must continue to develop systems to increase the efficiency and effectiveness of stroke care.3 The "D's of Stroke Care" remain the major steps in diagnosis and treatment of stroke and identify the key points at which delays can occur.4,5• Detection: Rapid recognition of stroke symptoms • Dispatch: Early activation and dispatch of emergency medical services (EMS) system by calling 911 • Delivery: Rapid EMS identification, management, and transport • Door: Appropriate triage to stroke center • Data: Rapid triage, evaluation, and management within the emergency department (ED) • Decision: Stroke expertise and therapy selection • Drug: Fibrinolytic therapy, intra-arterial strategies • Disposition: Rapid admission to stroke unit, critical-care unit This chapter summarizes the early management of acute ischemic stroke in adult patients.It describes care from out-ofhospital therapy through the first hours of in-hospital therapy.For additional information about the management of acute ischemic stroke, see the American Heart Association (AHA)/ American Stroke Association (ASA) guidelines for the management of acute ischemic stroke.3,6,