V-tach question

EricJRN, MSN, RN · Jan 10, 2007

I WOULD SUPPORT AS MY FIRST LINE OF DEFENSE ADENOSINE
STABLE SVT
UNDEFINED STABLE NARROW TACHYCARDIA AS A DIAGNOSTIC MANEUVER
NOT EFFECTIVE IN AFIB, AFLUTTER. OR VT

It's an old thread, but it looks like they were talking about VT, not SVT.

MARIAN202 · Jan 10, 2007

yes thanks the question is related to vt not svt

MARIAN202 · Jan 10, 2007

2006 ACLS FOUNDATION FACTS

UNDERSTANDING YOUR ROLES:

WHETHER YOU ARE A TEAM MEMBER OR TEAM LEADER DURING A RESUSCITATION ATTEMPT, YOU SHOULD UNDERSTAND NOT ONLY YOUR ROLE BUT ALSO THE ROLES OF OTHER TEAM MEMBERS ON YOUR TEAM. THIS AWARENESS WILL HELP YOU ANTICIPATE:
- WHAT ACTIONS WILL BE PERFORMED NEXT
- HOW TO COMMUNICATE AND WORK AS A MEMBER OR LEADER OF THE TEAM

MEDICAL EMERGENCY TEAMS (METs)

RAPID RESPONSE TEAMS (RRTs)

MEDICAL EMERGENCY TEAMS (METs) HAVE BEEN IMPLEMENTED IN MANY HOSPITALS.
THE PURPOSE OF THESE TEAMS IS TO PROVIDE PATIENT OUTCOMES BY IDENTIFYING AND TREATING EARLY CLINICAL DETERIORATION
IN-HOSPITAL CARDIAC ARREST IS COMMONLY PRECEDED BY PHYSIOLOGIC CHANGES.
IN ONE CASE STUDY, NEARLY 80% OF HOSPITALIZED PATIENTS WITH CARDIORESPIRATORY ARREST HAD ABNORNAL VITAL SIGNS DOCUMENTED FOR UP TO 8 HOURS BEFORE THE ACTUAL ARREST.
MANY OF THESE CHANGES CAN BE RECOGNIZED BY MONITORING ROUTINE VITAL SIGNS.
INTERVENTION BEFORE CLINICAL DETERIORATION OR CARDIAC ARREST MAY BE POSSIBLE.
CONSIDER THE QUESTION ASKED IN THE ACLS EXPERIENCED PROVIDER COURSE: “WOULD YOU HAVE DONE ANYTHING DIFFERENTLY IF YOU KNEW 15 MINUTES BEFORE THE ARREST THAT…?”
LEARN MORE ABOUT THE EVOLVING CONCEPT OF MEDICAL EMERGENCY TEAMS FROM THE STUDENT CD.

LONE HCP MAY TAILOR RESPONSE:

LONE HEALTHCARE PROVIDERS MAY TAILOR THE SEQUENCE OF ACTIONS TO THE MOST LIKELY CAUSE OF ARREST.
FOR PATIENT WITH A LIKELY ASPHYXIAL ARREST, THE LONE RESCUER SHOULD PERFORM 2 MINUTES (ABOUT 5 CYCLES) OF CPR BEFORE LEAVING THE PATIENT TO ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET AN AED.
THEN RETURN TO THE PATIENT, RESUME CPR, AND USE THE AED IF INDICATED.

PRECAUTIONS FOR OPAs AND NPAs

TAKE THE FOLLOWING PRECAUTIONS WHEN USING AN OPA OR NPA:
- ALWAYS CHECK SPONTANEOUS RESPIRATIONS IMMEDIATELY AFTER INSERTION OF EITHER AN OPA OR NPA
- IF RESPIRATIONS ARE ABSENT OR INADEQUATE, START POSITIVE-PRESSURE VENTILATIONS AT ONCE WITH AN APPROPRIATE DEVICE.
- IF ADJUNCTS ARE UNAVAILABLE, USE MOUTH-TO-MASK BARRIER VENTILATION.

RESCURE BREATHS FOR CPR WITH ADVANCED AIRWAY IN PLACE

RESCURE BREATHING WITHOUT ADVANCE CHEST COMPRESSIONS

DURING CPR THE COMPRESSIONS-TO VENTILATION RATIO IS 30:2.
BUT ONCE AN ADVANVANCED AIRWAY IS IN PLACE (i.e., ET TUBE, COMBITUBE, OR LMA),
CHEST COMPRESSSIONS ARE NO LONGER INTERRUPTED FOR VENTILATIONS.
WITH AN ADVANCED AIRWAY IN PLACE, GIVE 1 BREATH EVERY 6 TO 8 SECONDS (APPROXIMATELY 8 TO 10 BREATHS PER MINUTE)
WITH OUT TRYING TO SYNCHRONIZE BREATHS BETWEEN COMPRESSIONS.
IDEALLY THE BREATH SHOULD BE GIVEN DURING CHEST RECOIL BETWEEN CHEST COMPRESSIONS.
CONTINUOUSLY REEVALUATE COMPRESSIONS AND VENTILATIONS.
MODIFICATIONS MAY BE NECESSARY IF EITHER IS INEFFECTIVE.
IN THIS CASE THE PATIENT HAS A PULSE AND COMPRESSIONS ARE NOT INDICATED. GIVE 1VENTILATION EVERY 5 TO 6 SECONDS OR (APPROXIMATELY 10-12 BREATHS PER MINUTE.

STARTING CPR WHEN YOU ARE NOT SURE ABOUT PULSE

IF YOU ARE NOT SURE WHETHER THE PATIENT HAS A PULSE, YOU SHOULD BEGIN CYCLES OF COMPRESSIONS AND VENTILATIONS.
UNNECESSARY COMPRESSIONS ARE LESS HARMFUL THAN FAILING TO PROVIDE NECESSARY COMPRESSIONS WHEN THEY ARE NEEDED.
CPR IN A PATIENT WITH A PULSE IS NOT HARMFUL.
DELAYING OR FAILING TO START CPR IN A PATIENT WITHOUT A PULSE REDUCES THE CHANCE OF A SUCCESSFUL RESUSCITATION.

RESUME CPR WHILE MANUAL DEFIBRILLATOR IS CHARGING

RESUME CPR WHILE THE MANUAL DEFIBRILLATOR IS CHARGING IF CHARGING TAKES MORE THAN 10 SECONDS.
EVEN A 5- TO 10-SECOND PAUSE IN CHEST COMPRESSIONS REDUCES THE CHANCE THAT A SHOCK WILL TERMINATE VF.
FOR AN AED, FOLLOW MANUFACTURES’S PROMPTS.
NEW-MODEL MANUAL DEFIBRILLATIONS CHARGE RAPIDLY (
OLDER MODEL MANUAL DEFIBRILLATIORS MAY TAKE LONGER TO CHARGE, SO CHEST COMPRESSIONS DURING CHARGING ARE ADVISED TO MINIMIZE TIME BETWEEN LAST COMPRESSION AND SHOCK DELVERY.
YOU SHOULD KNOW YOUR MANUAL DEFIBRILLATOR CHARGE TIME AND WHETHER COMPRESSIONS DURING CHARGING ARE NEEDED.

CLEARING THE DEFIBRILLATION:

TO ENSURE SAFETY DURING DRFIBRILLATION, ALWAYS ANNOUNCE WHEN YOU ARE ABOUT TO DELIVER A SHOCK.
STATE WARNING AND IN A FORCEFUL VOICE
DELIVERING EACH SHOCK (THIS ENTIRE SEQUENCE SHOULD TAKE 5 SECONDS):
- “I AM GOING TO SHOCK ON THREE. ONE, I’M CLEAR.” CHECK TO MAKE SURE YOU ARE CLEAR OF CONTACT WITH THE PATIENT, THE STRECHER, OR THE OTHER EQUIPMENT.
- “TWO, YOU’RE CLEAR.” MAKE A VISUAL CHECK TO ENSURE THAT NO ONE IS TOUCHING THE PATIENT OR STRECHER. IN PARTICULAR, CHECK THE PERSON PROVIDING VENTILATIONS. THAT PERSON’S HANDS SHOULD NOT BE TOUCHING THE VENTILATORY ADJUNCTS, INCLUDING AN ADVANCED AIRWAY. BE SURE OXYGEN IS NOT FLOWING ACROSS THE PATIENT’S CHEST. TURN THE OXYGEN OFF OR DIRECT FLOW AWAY FROM THE PATIENT’S CHEST. IDEALLY, MAKE SURE THE SOURCE OF OXYGEN IS REMOVED FROM THE PATIENT WHEN YOU CLEAR THE PATIENT TO SHOCK.
- “THREE, EVERYBODY IS CLEAR” CHECK YOURSELF ONE MORE TIME BEFORE PRESSING THE SHOCK BUTTON.
- YOU NEED NOT USE THESE EXACT WORDS, BUT YOU MUST WARN OTHERS THAT YOU ARE ABOUT TO DELIVER SHOCKS AND THAT EVERYONE MUST STAND CLEAR.

PADDLES VS PADS

CONDUCTIVE MATERIALS ARE USED TO REDUCE TRANSTHORACIC IMPEDANCE (RESISTANCE TO THE ELECTRICAL CURRENT) TO SHOCKS.
CONDUCTIVE MATERIALS INCLUDE PADDLES WITH ELECTRODE PASTE, GEL PADS, OR SELF-ADHESIVE PADS.
NO EXITING DATA SUGGESTS THAT ONE IS BETTER.

USE OF SELF-ADHESIVE PADS WILL, HOWEVER:

REDUCE THE RISK OF ARCHING.
SELF-ADHESIVE PADS CAN ALSO BE APPLIED FOR MONITORING, AND
THEY ALLOW FOR THE RAPID DELIVERY OF A SHOCK IF NECESSARY. FOR THESE REASONS THEY ARE ROUTINELY RECOMMENDED INSTEAD OF PADDLES.

ASYSTOLE AND TECHNICAL PROBLEMS

ASYSTOLE IS A SPECIFIC DIAGNOSIS, BUT FLAT LINE IS NOT.

THE TERM FLAT LINE IS NONSPECIFIC AND COULD RESULT FROM SEVERAL POSSIBLE CONDITIONS,

1.INCLUDING ABSENCE OF CARDIAC ELECTRICAL ACTIVITY,

2.LEAD OR OTHER EQUIPMENT FAILURE, AND

3.OPERATOR ERROR.

SOME DEFIBRILLATORS AND MONITORS SIGNAL THE OPERATOR WHEN A LEAD OR OTHER EQUIPMENT FAILURE OCCURS.

SOME OF THESE PROBLEMS ARE NOT APPLICABLE TO ALL DEFIBRILLATORS.

FOR THE PATIENT WITH PULSELESS ARREST AND ASYSTOLE, QUICKLY RULE OUT ANY OTHER CAUSES OF AN ISOELECTRIC ECG, SUCH AS:

LOOSE LEADS OR LEADS NOT CONNECTED TO THE PATIENT OR DEFIBRILLATOR/MONITOR
NO POWER
SIGNAL GAIN (AMPLITUDE/SIGNAL STRENGTH) TOO LOW

OUT-OF-THE-HOSPITAL CARDIAC ARREST RESPONSE:

- HALF OF THE PATIENTS WHO WILL DIE OF ACS DO SO BEFORE REACHING THE HOSPITAL

- VF OR PULSELESS VT IS THE PRECIPITING RHYTHM IN MOST OF THESE DEATHS.

- VF IS MOST LIKELY TO DEVELOP DURING THE FIRST 4 HOURS AFTER ONSET OF SYMPTOMS.

COMMUNITIES SHOULD DEVELOP PROGRAMS TO RESPOND TO OUT-OF-THE-HOSPITAL CARDIAC ARREST. SUCH PROGRAMS SHOULD FOCUS ON:

1. RECOGNIZING SYSTOMS OF ACS

2. ACTIVATING THE EMS SYSTEM WITH EMS ADVANCE NOTIFICATION OF THE RECEIVING HOSPITAL

3. PROVIDING EARLY CPR

4. PROVIDING EARLY DEFIBRILLATION WITH AEDs AVAILABLE THROUGH PUBLIC ACCESS DEFIRILLATION PROGRAMS AND FIRST RESPONDERS

5. PROVIDING A COORDINATED SYSTEM OF CARE AMONG THE EMS SYSTEM, THE ED, AND CARDIOLOGY

SEDATION AND PACING

MOST AWAKE PATIENTS SHOULD BE GIVEN SEDATION BEFORE PACING
IF THE PATIENT IS IN CARDIOVASCULAR COLLAPSE OR RAPIDLY DETERIORATING, IT MAY BE NECESSARY TO START PACING WITHOUT PRIOR SEDATION, PARTICULARLY IF DRUGS FOR SEDATION ARE NOT IMMEDIATELY AVAILABLE.
THE CLINICIAN MUST EVALUATE THE NEED FOR SEDATION IN LIGHT OF THE PATIENT’S CONDITION AND NEED FOR IMMEDIATE PACING.
A REVIEW OF THE DRUGS USED IS BEYOND THE SCOPE OF THE ACLS PROVIDER COURSE
THE GENERAL APPROACH COULD INCLUDE THE FOLLOWING:
- GIVE PARENTERAL BENZODIAZEPINE FOR ANXIETY AND MUSCLE CONTRACTIONS
- GIVE A PARENTERAL NARCARTIC FOR ANALGESIA
- OBTAIN EXPERT CONSULTATION FOR TRANSVENOUS PACING

SERIOUS OR SIGNIFICANT SYMPTOMS

UNSTABLE CONDITIONS

INTERVENTION IS DETERMINED BY THE PRESENCE OF SIGNIFICANT SYMPTOMS OR BY AN UNSTABLE CONDITION RESULTING FROM THE TACHYCARDIA.*(VENTRICULAR RATES (

SERIOUS SYMPTOMS AND SIGNS INCLUDE:
- ALTERED MENTAL STATUS
- ONGOING CHEST DISCOMFORT OR
- SHORTNESS OF BREATH
- PRESYNCOPE OR SYNCOPE

UNSTABLE PATIENTS INCLUDE THOSE WITH:
- HYPOTENSION
- SIGNS OF SHOCK

TREATMENT BASED ON TYPE OF TACHYCARDIA

YOU MAY NOT ALWAYS BE ABLE TO DISTINGUISH BETWEEN SUPRAVENTRICULAR AND VENTRICULAR RHYTHMS.
MOST WIDE-COMPLEX (BROAD-COMPLES) TACHYCARDIAS ARE VENTRICULAR IN ORGIN (ESPECIALLY IF THE PATIENT HAS AN UNDERLYING HEART DISEASE OR IS OLDER).
IF THE PATIENT IS PULSELESS, TREAT THE RHYTHM AS VF AND FOLLOW THE ACLS PULSELESS ARREST ALGORITHM
IF THE PATIENT HAS A WIDE-COMPLEX TACHYCARDIA AND IS UNSTABLE, ASSUME IT IS VT UNTIL PROVEN OTHERWISE.
THE AMOUNT OF ENERGY REQUIRED FOR CARDIOVERSION OF VT IS DETERMINED BY MORPHOLOGIC CHARACTERISTICS
- A REGULAR UNIFORM WIDE-COMPLEX VT IS CALLED MONOMORPHIC VT
- IF THE PATIENT IS UNSTABLE BUT HAS A PULSE, DO THE FOLLOWING:

- TREAT WITH SYNCHRONIZED CARDIOVERSION AND AN INITIAL SHOCK OF 100 J (MONOPHASIC WAVEFORM)

- IF THERE IS NO RESPONSE TO THE FIRST SHOCK, INCREASE THE DOSE IN A STEPWISE FASHION(200 J, 300 J, 360 J)

- IF THE PATIENT HASA POLYMORPHIC VT AND IS STABLE:
  - TREAT THE VT WITH HIGH-ENERGY UNSYNCHRONIZED SHOCKS (e.g., DEFIBRILLATION DOSES)

IF THERE IS ANY DOUBT ABOUT WHETHER

1. UNSTABLE PATIENT HAS MONOMORPHIC OR POLY MORPHIC VT,

2. DO NOT DELAY TREATMENT FOR FUTHER RHYTHM ANALYSIS.

3. PROVIDE HIGH-ENERGY, UNSYNCHRONIZED SHOCKS.

UNDERSTANDING SINUS TACHYCARDIA

SINUS TACHYCARDIA IS A HEART RATE GREATER THAN 100 BPM AND IS GENERATED BY SINUS NODE DISCHARGE
THE HEART RATE IS SINUS TACHYCARDIA DOES NOT EXCEED 180 BPM EXCEPT IN YOUNG PEOPLE DURING STRENUOUS PHYSICAL EXERCISE
AT REST SINUS TACHYCARDIA USUALLY DOES NOT EXCEED 120 TO 130 BPM, AND IT HAS A GRADUAL TERMINATION.
REENTRY SVT HAS AS ABRUPT ONSET AND TERMINATION

- SINUS TACHYCARDIA IS CAUSED BY EXTERNAL INFLUNCES ON THE HEART, SUCH AS:

1. FEVER

2. BLOOD LOSS OR

3. EXERCISE

THESE ARE SYSTEMIC CONDITIONS, NOT CARDIAC CONDITIONS.

SINUS TACHYCARDIA IS A REGULAR RHYTHM, ALTHOUGH THE RATE MAY BE SLOWED BY VAGAL MANEUVERS
CARDIOVERSION IS CONTRAINDICATED.
B-BLOCKERS MAY CAUSE CLINICAL DETERIORATION IF THE CARDIAC OUT PUT FALLS WHEN A COMPENSATORY TACHYCARDIA IS BLOCKED
THIS IS BECAUSE CARDIAC OUT PUT IS DETERMINED BY THE VOLUME OF BLOOD EJECTED BY THE VENTRICLES WITH EACH CONTRACTION (STROKE VOUME) AND THE HEART RATE.
CARDIAC OUTPUT (CO) = STROKE VOLUME (SV) X HEART RATE
IF A CONDITION SUCH AS LARGE AMI LIMITS VENTRICULAR FUNCTION (SEVERE HEART FAILURE OR
CARDIOGENIC SHOCK), THE HEART COMPENSATES BY INCREASING THE HEART RATE.

IF YOU ATTEMPT TO REDUCE THE HEART RATE IN PATIENTS WITH A COMPENSATORY TACHYCARDIA, CARDIAC OUTPUT WILL FALL AND THE PATIENT’S CONDITION WILL LIKELY DETERIORATE.

IN SINUS TACHYCARDIA THE GOAL IS TO IDENTIFY AND TREAT THE UNDERLYING SYSTEMIC CAUSE.

TREATING TACHYCARDIA:

YOU MAY NOT ALWAYS BE ABLE TO DISTINGUISH BETWEEN SUPRAVENTRICULAR (ABERRANT) AND VENTRICULAR WIDE-COMPLEX RHYTHMS.
IF YOU ARE UNSURE, BE AWARE THAT MOST WIDE-COMPLEX (BROAD-COMPLEX) TACHYCARDIAS ARE VENTRICULAR IN ORGIN
IF A PATIENT IS PULSELESS OR WITH SEVERE SIGNS OF DECOMPENSATING SHOCK, FOLLOW THE ACLS PULSELESS ARREST ALGORITHM.
IF A PATIENT BECOMES UNSTABLE, DO NOT DELAY TREATMENT FOR FUTHER RHYTHM ANALYSIS.
FOR STABLE PATIENTS WITH WIDE-COMPLEX TACHYCARDIAS:
- TRANSPORT AND MONITOR OR
- CONSULT AN EXPERT BECAUSE TREATMENT HAS THE POTENTIAL FOR HARM.

MAJOR TYPES OF STROKE

STROKE IS THE GENERAL TERM.
IT REFERS TO ACUTE NEUROLOGIC IMPAIRMENT THAT FOLLOWS INTERRPUTION IN BLOOD SUPPLY TO A SPECIFIC AREA OF THE BRAIN
ALTHOUGH EXPEDITIOUS STROKE CARE IS IMPORTANT TO ALL PATIENTS, THIS CASE EMPHASIZES REPERFUSION THERAPY FOR ACUTE ISCHEMIC STROKE.

THE MAJOR TYPES OF STROKES ARE:

ISCHEMIC STROKE-ACCOUNTS FOR 85% OF ALL STROKES AND IS USUALLY CAUSED BY AN OCCLUSION OF AN ARTERY TO A REGION OF THE BRAIN
HEMORRHAGIC STROKE- ACCOUNTS FOR 15% OF ALL STROKES AN OCCURS WHEN A BLOOD VESSEL IN THE BRAIN SUDDENLY RUPTURES INTO THE SURROUNDING TISSUE. FIBRINOLYTICS ARE CONTRAINDICATED IN THIS TYPE OF STROKE. AVOID ANTICOAGULANTS.

STROKE CHAIN OF SURVIVAL

THE GOAL OF THE STROKE IS TO MINIMIZE BRAIN INJURY AND MAXIMIZE THE PATIENT’S RECOVERY.
THE CHAIN OF SURVIVAL DESCRIBED BY THE AHA AND THE AMERICIAN STROKE ASSOCIATION IS SIMULAR TO THE CHAIN OF SURVIVAL FOR SUDDEN CARDIAC ARREST.
IT LINKS ACTIONS TO BE TAKEN BY PATIENTS, FAMILY MEMBERS, AND HEALTHCARE PROVIDERS TO MAXIMIZE STROKE RECOVERY.
THESE LINKS ARE:
- RAPID RECOGNITION AND REACTION TO STROKE WARNING SIGNS
- RAPID EMS DISPATCH
- RAPID EMS SYSTEM TRANSPORT AND PREARRIVAL NOTIFICATION TO THE RECEVING HOSPITAL
- RAPID DIANOSIS AND TREATMENT IN THE HOSPITAL

THE 7 D’S OF STROKE CARE

THE 7 D’S OF STROKE CARE HIGHLIGHT THE MAJOR STEPS IN DIAGNOSIS AND TEATMENT OF STROKE AND KEY POINTS AT WHICH DELAYS CAN OCCUR:

DETECTION OF THE ONSET OF SIGNS AND SYMPTOMS OF STROKE
DISPATCH OF EMS (BY TELEPHONING 911 OR EMERGENCY RESPONSE NUMBER)
DELIVERY WITH ADVANCE PREHOSPITAL NOTIFICATION TO A HOSPITAL CAPABLE OF PROVIDING ACUTE STROKE CARE
DOOR OF THE ED, INCLUDING ARRIVAL AND URGENT TRIAGE IN ED
DATA, INCLUDING COMPUTED TOMOGRAPHY (CT) SCAN AND INTERPRETATION OF THE SCAN
DECISION REGARDING TREATMENT, INCLUDING FIBRINOLYTICS
DRUG ADMINISTRATION (AS APPROPRIATE) AND POSTADMINISTRATION MONITORING

FACTS:

NINDS

THE NATIONAL INSTITUTE OF NEUROLOGIC DISORDERS AND STROKE (NINDS) IS A BRANCH OF THE NATIONAL INSTITUTES OF HEALTH (NIH).
THE MISSION OF THE NINDS IS TO REDUCE THE BURDEN OF NEUROLOGIC DISEASES BY SUPPORTING AND CONDUCTING RESEARCH.
NINDS RESEARCHERS HAVE STUDIED STROKE AND REVIEWED DATA LEADING TO RECOMMENDATIONS FOR ACUTE STROKE CARE.
NINDS HAS A SET CRITICAL TIME GOALS FOR ASSESSMENT AND MANAGEMENT OF STROKE VICTIMS BASED ON EXPERIENCE OBTAINED IN LARGE STUDIES OF STROKE VICTIMS.

STROKECENTERS AND STROKE UNITS

INITIAL EVIDENCE INDICATES A FAVORABLE BENEFIT FROM TRIAGE OF STROKE PATIENT DIRECTLY TO DESIGNATED STROKE CENTERS, BUT THE CONCEPT OF ROUTINE OUT-OF-THE-HOSPITAL TRIAGE OF STROKE PATIENTS REQUIRE CONTINUED EVALUATION.
EACH RECEIVING HOSPITAL SHOULD DEFINE ITS CAPABILITIES FOR TREATING PATIENTS WITH ACUTE STROKE AND SHOULD COMMUNICATE THIS INFORMATION TO THE EMS SYSTEM AND THE COMMUNITY.
ALTHOUGH NOT EVERY HOSPITAL HAS THE RESOURCES TO SAFELY ADMINISTER FIBRINOLYTICS, EVERY HOSPITAL WITH AN ED SHOULD HAVE A WRITTEN PLAN THAT DESCRIBES HOW PATIENTS WITH ACUTE STROKE WILL BE MANAGED IN THAT
THE PLAN SHOULD: INSTITUTION.
- DETAIL THE ROLES OF THE HEALTHCARE PROVIDERS IN THE CARE OF PATIENTS WITH ACUTE STROKE, INCLUDING IDENTIFYING SOURCES OF NEUROLOGIC EXPERTISE
- DEFINE WHICH PATIENT TO TREAT WITH FIBRINOLYTICS AT THAT FACILITY
- DESCRIBE WHEN PATIENT TRANSFER TO ANOTHER HOSPITAL WITH A DEDICATED STROKE UNIT IS APPROPRIATE

- - WHEN A STROKE UNIT WITH A MULTIDISCIPLINARY TEAM EXPERIENCED IN MANAGING STROKE IS AVAILALBLE WITHIN A REASONABLE TRANSPORT INTERVAL, PATIENTS WITH STROKEWHO REQUIRE HOSPITALIZATION SHOULD BE ADMITTED TO A STROKE UNIT.

STUDIES HAVE DOCUMENTED IMPROVEMENT IN 1-YEAR SURVIVAL RATE, FUNCTIONAL OUTCOMES, AND QUALITY OF LIFE WHEN PATIENTS HOSPITALIZED FOR ACUTE STROKE RECEIVE CARE IN A DEDICATED UNIT WITH A SPECIALIZED TEAM.