Acute Stroke Care Guide

Outcomes for individuals with stroke have improved significantly due to the implementation of the Acute Stroke System of Care. The community is better equipped to recognize stroke as a “brain attack,” and there is greater awareness of the importance of medical care within three hours of symptom onset because you will have the opportunity to reverse said symptoms with the fibrinolytic. Likewise, EMS systems have been enhanced to transport individuals to regional stroke care centers that are equipped to administer fibrinolytics.

Stroke Chain of Survival

FAST Acronym

The FAST acronym is based on the Cincinnati Pre-Hospital Stroke Scale and is used to evaluate when someone is having a stroke.

FACE	Grimace or drooping on one side
ARMS	Weakness drift or paralysis on the same side
SPEECH	Slurred or incomprehensible
TIME	Time of activity and time to call 911

GOALS OF ACUTE ISCHEMIC STROKE CARE

The overall goal of stroke care is to minimize brain injury and optimize the individual’s recovery. Preferential transport to stroke-capable centers has been shown to improve outcomes. Stroke centers are equipped with resources often not available at smaller community hospitals. The presence of specialists, including neurologists and stroke care specialists, multidisciplinary teams experienced in stroke care, advanced imaging modalities, and other therapeutic options make transport to stroke centers the most suitable option. The goal of the stroke team, emergency physician, or other experts should be to assess the individual with suspected stroke within ten minutes.

The 8 D’s of Stroke Care (Table 2) highlight the major steps of diagnosis and treatment of stroke and key points at which delays can occur.

The 8 D’s of Stroke Care

DETECTION	Rapid recognition of stroke symptoms
DISPATCH	Early activation and dispatch of EMS
DELIVERY	Rapid EMS identification, management, and transport
DOOR	Adhere to all door to delivery times, such as door to needle in < 60 minutes, etc.
DATA	Rapid triage, evaluation, and management in ED
DECISION	Stroke expertise and therapy selection
DRUG	Fibrinolytic therapy, intra-arterial strategies
DISPOSITION	Rapid admission to the stroke unit or critical care unit