Acute medical therapy

Abstract

The management of the acute stroke patient requires a coordinated, multidisciplinar y effort. In most emergency departments, the ratio of stroke to stroke mimics is 1 to 4 or i to 5. Therefore, there must be an efficient, skilled procedure for eliminating those diseases that mimic stroke such as Todd's paralysis, transient ischemic attacks (TIA), hysteria, migraine, and carpal ~nnel syndrome. Stroke patients must be stabilized according to basic protocols (airway, breathing, circulation) before neurologic evaluation begins; this process should require no more than a minute or two. Stroke management then includes diagnosis and possibly treatment. All of this is best accomplished with an institutionalized Stroke Team, comparable with a Code Blue team that rehearses, monitors performance, and uses feedback to continually improve care. Most of the time, acute stroke care will be merely supportive. In a small number of cases, however, thrombolysis will be indicated. Because the use of thrombolytic therapy is complicated, we devote the majority of our remarks to its use including rationale, patient selection, and drug administration. Brief remarks will be included for nonspecific management.