Early Management of Ischemic Stroke.pptVIP

Early Management of Ischemic Stroke Ri 王慧懿/ P柯文哲 Reference Guidelines for the Early Management of Adults With Ischemic Stroke Stroke 2007;38;1655-1711 Acute ischemic stroke N Engl J Med 2007; 357:572-579, Aug 9, 2007 Early Diagnosis: Brain and Vascular Imaging Imaging of the brain is recommended before initiating any specific therapy to treat acute ischemic stroke (Class I, Level of Evidence A). In most instances, CT will provide the information to make decisions about emergency management (Class I, Level of Evidence A). The brain imaging study should be interpreted by a physician with expertise in reading CT or MRI studies of the brain (Class I, Level of Evidence C). Some findings on CT, including the presence of a dense artery sign, are associated with poor outcomes after stroke (Class I, Level of Evidence A). Multimodal CT and MRI may provide additional information that will improve diagnosis of ischemic stroke (Class I, Level of Evidence A). Nevertheless, data are insufficient to state that, with the exception of hemorrhage, any specific CT finding (including evidence of ischemia affecting more than one third of a cerebral hemisphere) should preclude treatment with rtPA within 3 hours of onset of stroke (Class IIb, Level of Evidence A). Vascular imaging is necessary as a preliminary step for intra-arterial administration of pharmacological agents, surgical procedures, or endovascular interventions (Class IIa, Level of Evidence B). Emergency treatment of stroke should not be delayed in order to obtain multimodal imaging studies (Class III, Level of Evidence C). Vascular imaging should not delay treatment of patients whose symptoms started 3 hours ago and who have acute ischemic stroke (Class III, Level of Evidence B). General Supportive Care and Treatment ofAcute Complications High blood pressure High serum level of glucose High body temperature ?poor long term outcomes Patient not perform rt-PA Markedly elevated blood pressure ?lowered G