You have a possible acute ischemic stroke patient in the ED who may be a candidate for tPA. There’s no neurologist readily available to guide the treatment decision. What should you do?
Explore This IssueACEP14 Daily News Wednesday: Vol 33 - No10C - October 2014
That’s just the sort of scenario that will be covered in “Are You Ready to Give tPA in Ischemic Stroke? Practical Considerations for Real-Life Use,” said Andrew W. Asimos, MD, FACEP, director of emergency stroke care at Carolinas Medical Center in Charlotte, North Carolina, and professor in the department of emergency medicine at Carolinas HealthCare System.
Dr. Asimos’s session will review the practical steps emergency physicians must face when deciding whether to use tPA. He will also cover post-seizure states that can mimic strokes, strokes in the elderly, stroke severity, and the importance of vessel occlusion to gauge the probable effectiveness of tPA.
Dr. Asimos will stress the importance of rapid treatment in patients suspected for an ischemic stroke. “They need to be evaluated and treated as rapidly as possible. That’s the most important message,” he said. Quicker treatment can lead to less disability.
Although emergency physicians are always focused on rapid treatment, it’s even more important now with a new Joint Commission Primary Stroke Center requirement specifying that at least 50 percent of those treated with intravenous tPA need to receive their treatment within an hour, Dr. Asimos said. “If the ED doesn’t do its part quickly, everyone will get behind the eight ball.”
Dr. Asimos will also talk about patients deemed as having minor strokes and discuss the value of treating those patients with tPA. “I only classify these patients as too good to treat if their deficits are nondisabling,” he said.
The session will also briefly cover the update to ACEP’s Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.
Vanessa Caceres is a freelance medical writer based in Florida.