Urgent - Management
my part question is : What alternative approaches/modifications on Stroke in Emergency department
1 page.Due in 7 hours.1
Guidelines for Management of
Stroke
Ulaanbaatar 2012
2
Contents
Abbreviations 4
Introduction 5
А. General Part 6-8
А.1. Definition of Stroke
А.2. International Classification Disease Codes
А.3. Users of this Guideline
А.4. Objective
А.5. Processed Data
А.6. Update Data
А.7. Participants in preparing this guideline
А.8. Used terminology
A.9. Epidemiology
B. Management of Ischemic Stroke 8-20
B.1. Evaluation and management of acute stroke
B.1.1. Orders and steps of emergency medical services
B.1.2. Referral and patient transfer
B.1.3. Emergency room management of Acute Stroke
B.1.4. Diagnosis of Stroke
B.1.5. Treatment decisions by stroke team
B.1.6. Treatment for Ischemic Stroke
B.1.6.1. General stroke treatment
B.1.6.2. Specific treatment
B.1.6.3. Thrombolytic therapy
B.1.6.4. Management for Hypertension
B.1.6.4.1. Management of hypertension in patients eligible or not eligible for
thrombolytic therapy
B.1.6.5. Antiplatelet and anticoagulant therapy
3
D. Management of Spontaneous Intracerebral Hemorrhage 20-26
C.1. Diagnosis of Intracerebral hemorrhage
C.2. Treatment of acute Intracerebral hemorrhage
C.2.1. Air way and oxygenation
C.2.2. Medical treatment
C.2.3. Blood pressure management
C.2.4. Surgical removal of Intracerebral hemorrhage
D. Management of Aneurysmal Subarachnoid Hemorrhage 26-30
D.1. Manifestations and diagnosis of aneurysmal SAH
D.2. Medical management of SAH
D.3. Surgical and endovascular treatment of ruptured cerebral aneurysms
D.4. Medical measures to prevent re-bleeding after SAH
D.5. Management of cerebral vasospasm
E. Management of complications in Strokes 31-34
E.1. Therapy of elevated Intracranial pressure and Hydrocephalus
E.1.1. Management of intracranial pressure
E.2. Prevention and management of other complications in Strokes
F. Rehabilitation 34-35
H. Prevention of Stroke 35-39
H.1. Primary prevention
H.2. Secondary prevention
I. Application of the guidelines for management of stroke
in each level of medical organizations 40
References 41
4
Abbreviations
AF atrial fibrillation
BP blood pressure
CAS carotid artery stenting
CEA carotid endarterectomy
CE-MRA contrast-enhanced MR angiography
CSF cerebral spinal fluid
CT computed tomography
CTA computed tomography angiography
CV cardiovascular
DSA digital subtraction angiography
DWI diffusion-weighted imaging
ECG electrocardiography
ED emergency department
EEG electroencephalography
EMS emergency medical service
FLAIR fluid attenuated inversion recovery
ICA internal carotid artery
ICP intracranial pressure
INR
ICH
international normalized ratio
Intracerebral hemorrhage
iv
IS
intravenous
Ischemic stroke
LDL low density lipoprotein
MCGlobal Stroke
Guidelines and Action Plan:
A Road Map for Quality Stroke Care
PRehoSPitAl And
eMeRgenCy CARe
Authors: Lindsay MP, Norrving B, Furie KL, Donnan G, Langhorne P, Davis S
On Behalf of the Global Stroke Quality and Guidelines Advisory Committee,
the Global Stroke Guidelines Working Group,
and the Global Stroke Quality Working Group.
Global Stroke Services Guidelines and Action Plan: Achieving and Monitoring Quality Stroke Care 2
PrehosPital and emergency care
A RoAd MAp foR QuAlity StRoke CARe
PuRPoSe:
The WSO Roadmap to Delivering Quality Stroke Care is an implementation resource to accompany the
WSO Global Stroke Services Guideline and Action Plan. This roadmap provides the framework for the
implementation, monitoring and evaluation of stroke services globally.
It provides standardization and consistency for the selection of evidence-based recommendations,
approaches to implementations in clinical practice, and the calculation of performance measures to create
an environment of continuous quality improvement.
tARget AudienCe:
The roadmap is intended to guide local healthcare officials and stroke care clinical groups in establishing
stroke systems of care and implementing as many of the defined components as possible throughout the
stroke continuum of care. The focus of the roadmap is on the processes of care and impacts on patient
outcomes. It is recognized that not all regions will be able to provide all elements of quality stroke care;
therefore the recommendations and performance indicators take into account what should be possible
within three levels of service access.
It can be used by local, regional, or country-level health authorities and service providers as a foundation
for their own evaluation frameworks for stroke.
governments and funders should use these guidelines and action plan to review existing services, and identify
service gaps. These groups could then prioritize gaps and look for solutions to improve access to services.
Clinicians and other healthcare workers should use these guidelines and roadmap to scrutinize local care
delivery, access to care and ongoing support to achieve recovery goals.
This roadmap will also provide valuable guidance to stroke programs under development, to help ensure
that all key elements defined here are considered from the beginning of development.
FoRMAt:
The roadmap is organized along the continuum of care starting at the onset of a stroke event through the
acute phase (emergency department and inpatient care), stroke rehabilitation, prevention of recurrent stroke
and concludes with community reintegration and long term recovery.
Each section represents a part of the continuum and enables users to review and assess the structural
elements and services available for stroke care; core evidence-based best practice recommendations
related to processes of care that should be operational; and, a list of key quality indicators to monitor levelsGlobal Stroke
Guidelines and Action Plan:
A Road Map for Quality Stroke Care
PRehoSPitAl And
eMeRgenCy CARe
Authors: Lindsay MP, Norrving B, Furie KL, Donnan G, Langhorne P, Davis S
On Behalf of the Global Stroke Quality and Guidelines Advisory Committee,
the Global Stroke Guidelines Working Group,
and the Global Stroke Quality Working Group.
Global Stroke Services Guidelines and Action Plan: Achieving and Monitoring Quality Stroke Care 2
PrehosPital and emergency care
A RoAd MAp foR QuAlity StRoke CARe
PuRPoSe:
The WSO Roadmap to Delivering Quality Stroke Care is an implementation resource to accompany the
WSO Global Stroke Services Guideline and Action Plan. This roadmap provides the framework for the
implementation, monitoring and evaluation of stroke services globally.
It provides standardization and consistency for the selection of evidence-based recommendations,
approaches to implementations in clinical practice, and the calculation of performance measures to create
an environment of continuous quality improvement.
tARget AudienCe:
The roadmap is intended to guide local healthcare officials and stroke care clinical groups in establishing
stroke systems of care and implementing as many of the defined components as possible throughout the
stroke continuum of care. The focus of the roadmap is on the processes of care and impacts on patient
outcomes. It is recognized that not all regions will be able to provide all elements of quality stroke care;
therefore the recommendations and performance indicators take into account what should be possible
within three levels of service access.
It can be used by local, regional, or country-level health authorities and service providers as a foundation
for their own evaluation frameworks for stroke.
governments and funders should use these guidelines and action plan to review existing services, and identify
service gaps. These groups could then prioritize gaps and look for solutions to improve access to services.
Clinicians and other healthcare workers should use these guidelines and roadmap to scrutinize local care
delivery, access to care and ongoing support to achieve recovery goals.
This roadmap will also provide valuable guidance to stroke programs under development, to help ensure
that all key elements defined here are considered from the beginning of development.
FoRMAt:
The roadmap is organized along the continuum of care starting at the onset of a stroke event through the
acute phase (emergency department and inpatient care), stroke rehabilitation, prevention of recurrent stroke
and concludes with community reintegration and long term recovery.
Each section represents a part of the continuum and enables users to review and assess the structural
elements and services available for stroke care; core evidence-based best practice recommendations
related to processes of care that should be operational; and, a list of key quality indicators to monitor levels
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