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Update on the Management of Acute Stroke

Stroke is the fifth leading cause of death in the United States, and prompt, effective treatment is key to improving outcomes. A team of experts discuss advances in the management of acute ischemic stroke, including endovascular treatment, tPA prescribing guidelines, systems of care, and telemedicine, in this series moderated by Dr. Edward C. Jauch.

Edward C. Jauch, MD, MS
Professor, Director, Division of Emergency Medicine, Professor, Department of Neurosciences, Vice Chair, Research, Department of Medicine, Medical University of South Carolina
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Expert Presentations
Opeolu Adeoye, MD, MS, FACEP, FAHA
Associate Professor of Emergency Medicine, University of Cincinnati
Christine Holmstedt, DO, FAHA
Associate Professor of Neurology and Emergency Medicine, Medical Director, MUSC Comprehensive Stroke Program and MUSC Neuroscience Telehealth
Latest Comments
"This was an exceptional, evidence-based, well-organized, succinct program entitled "Intrahospital Stroke Systems of Care: The Need for Speed.”  You thoroughly provided relevant information including a case of an individual with stroke S/S, as well as, pertinent question, feedback and rationales.  The necessity to treat pt quickly, efficiently and effectively in a timely manner is a must.  Paramedics who first encounter the victim are typically busy with airway management, establishing an IV and an EKG and the onset, HX, S/S etc.  So, we truly need forms with check off lists for easy transferal of care to the ER personnel so the information is completed as the time of arrival or soon after.  You discussed the burden of stroke disability and death in the America.

Time is Brain and the window of opportunity for corrective treatment was analyzed.  The importance of time and favorable outcome time frames from onset of S/S to definitive TX were methodically reviewed.  A review of the history of TX guidelines regarding protocol according to the standards through the American Heart Association and Stoke Association were analyzed.

As for premixing tPA ,my institution would most like not endorse the strategy of premixing a costly drug like tPA prior to an ERP and Radiologist interpretation of CT and pt HX to warrant administration.  I do agree time is brain and early access and early intervention are vital toward a pt’s outcome, but until clearance is given, I know my hospital would not waste an expensive drug mixing prior approval to give.  From my memory in giving this drug in the past, I believe that once constituted it is only good for a few hours and if you don’t have another pt in need of the drug within that time frame the drug would have to be discarded. 

Yes, I agree that it does take some time to mix the medication prior to administration, but I believe that this is an issue that the pharmaceutical companies should work on making it easier to prepare.  Just like a code situation where we simply tear off the bottom of the packages of epinephrine lido canine etc.  They are so easy to quickly prepare and administer in a timely manner.

Thanks for an interesting program offering.

Valerie Ting, FNP-BC


Does your institution have a standard stroke flowchart that continuing from the field and is interchangeable from Paramedic, ER nurse to ERP?"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
"This was an exceptional evidence-based well-organized succinct program regarding two case histories entitled "Applying the Prescribing Information for IV tPA."  You thoroughly provided pertinent information regarding two case HX of  individuals presenting within the window period for CVA S/S and tPA TX.

Again a meticulous review of 2006 and current guidelines for tPA.  Great questions with immediate feedback and rationales.


I know it use to be limited to limited to a 3 hour restriction to tPA TX.  I have read the guidelines may have increased to 4 hours.

So, is it now 4.5 or 6 hour window period from onset of S/S to definitive treatment for  TPA administration for CVAs?


Valerie Ting, FNP-BC"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center

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