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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Stroke care: initial data from a county-based bypass protocol for patients with acute stroke.

Syed F Zaidi1, Julie Shawver2, Aixa Espinosa Morales1

  • 1Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.

Journal of Neurointerventional Surgery
|June 26, 2016
PubMed
Summary

Implementing the Rapid Arterial Occlusion Evaluation (RA) protocol significantly improved emergency medical service (EMS) stroke care. This protocol enhanced treatment rates and reduced critical times for both IV thrombolysis and mechanical thrombectomy, benefiting acute stroke patients.

Keywords:
StandardsStroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Early identification and transfer of acute stroke patients to specialized centers improve outcomes.
  • The effectiveness of emergency medical service (EMS)-driven protocols for acute stroke management is an area of ongoing research.

Purpose of the Study:

  • To implement and evaluate an EMS-driven stroke protocol using the Rapid Arterial Occlusion Evaluation (RACE) score in Lucas County, Ohio.
  • To compare the efficiency and outcomes of the RACE Alert (RA) protocol with standard stroke-alert protocols.

Main Methods:

  • EMS personnel (N=464) were trained in the RACE score.
  • The RA protocol directed patients with a RACE score ≥5 to facilities offering advanced stroke therapy.
  • Data on time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were collected and compared between the RA protocol (N=109) and standard stroke-alert patients (N=142).

Main Results:

  • The RA protocol group showed increased treatment rates for IV tissue plasminogen activator (25.6% vs 12.6%) and improved time efficiencies (door-to-CT: 10 vs 28 min; door-to-needle: 46 vs 75 min).
  • Mechanical thrombectomy rates increased (20.1% vs 7.7%), with significantly improved arrival-to-puncture (68 vs 128 min) and arrival-to-recanalization times (101 vs 205 min) in the RA cohort.
  • Diagnostic specificity for ischemic stroke improved (52.3% vs 30.1%) with the RA protocol.

Conclusions:

  • EMS adaptation of the RA protocol is feasible and effective for early triage and treatment of stroke patients.
  • The RA protocol significantly improves treatment times for both systemic thrombolysis and mechanical thrombectomy, leading to better patient outcomes.