Ischemic Stroke Guideline UpdateManagement of acute arterial ischemic stroke
This guideline update provides up-to-date comprehensive recommendations for the management and treatment of persons with acute arterial ischemic stroke. Audiences for this ischemic stroke guideline update are: prehospital care providers, physicians, nurses, allied health professionals and hospital administrators. This new guideline updates the 2018 acute ischemic guideline and adds several new recommendations.
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Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.
Try this ischemic stroke presentation case and find out if you’re following the most current guideline.
A 76 year old, previously healthy female is being transported by EMS for stroke symptoms.
She has a new onset gaze palsy, difficulty with speech, unilateral weakness/numbness, somnolence, and confusion.
What do most recent AHA guidelines recommend with regard to initial management of the above patient?
In patients eligible for alteplase, centers should strive for an < 60-minute door-to-needle time for administering the IV fibrinolysis.
In patients who awaken with stroke symptoms, IV alteplase may be beneficial despite the unknown stroke onset time if certain emergent imaging criteria are met.
Centers should strive for an < 20-minute door-to-imaging time in patients with acute stroke symptoms.
If a new EMS stroke-amenable-to thrombectomy screen suggests carotid or large intracranial vessel occlusion (LVO), then bypassing the closest hospital capable of IV thrombolysis in favor of a hospital capable of both IV alteplase and mechanical thrombectomy improves outcome as long as the delay is < 10 minutes (P=0.02).
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About Guideline Knowledge Checks:
With each update of national clinical practice guidelines, some recommendations change and many remain unchanged. Med-Challenger Guideline Knowledge Checks help you know both what is new and what has stayed the same in the most recent guidelines pertinent to each medical specialty.
About the Author:
Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.
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