Part 9: Adult Stroke

Each year in the United States about 700 000 people of all ages suffer a new or repeat stroke. Approximately 158 000 of these people will die, making stroke the third leading cause of death in the United States.1,2 Many advances have been made in stroke prevention, treatment, and rehabilitation.3,4 For example, fibrinolytic therapy can limit the extent of neurologic damage from stroke and improve outcome, but the time available for treatment is limited.5,6 Healthcare providers, hospitals, and communities must develop systems to increase the efficiency and effectiveness of stroke care.3 The “7 D’s of Stroke Care”—detection, dispatch, delivery, door (arrival and urgent triage in the emergency department [ED]), data, decision, and drug administration—highlight the major steps in diagnosis and treatment and the key points at which delays can occur.7,8 This chapter summarizes the management of acute stroke in the adult patient. It summarizes out-of-hospital care through the first hours of therapy. For additional information about the management of acute ischemic stroke, see the AHA/American Stroke Association (ASA) guidelines for the management of acute ischemic stroke.9,10 The goal of stroke care is to minimize brain injury and maximize patient recovery. The AHA and ASA developed a community-oriented “Stroke Chain of Survival” that links actions to be taken by patients, family members, and healthcare providers to maximize stroke recovery. These links are The AHA ECC stroke guidelines focus on the initial out-of-hospital and ED assessment and management of the patient with acute stroke as depicted in the algorithm Goals for Management of Patients With Suspected Stroke (Figure). The time goals of the National Institute of Neurological Disorders …