Chapter 11 Rapid Clinical Evaluation

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Publisher Summary

This chapter discusses rapid clinical evaluation. Prompt and efficient clinical evaluation is essential to deliver acute therapies effectively in the case of stroke. The evaluation of the acute stroke patient is an urgent and iterative process. Succeeding caretakers and providers in the healthcare system—dispatchers, ambulance personnel, emergency department (ED) nurses, emergency physicians, neurologists, and others—perform rapid evaluations of increasing detail. The “stroke chain of survival and recovery” is a useful framework for conceptualizing integrated prehospital and ED acute stroke care, including clinical evaluation. The “seven Ds” in the stroke chain of survival or recovery are: (1) detection of the onset of stroke signs and symptoms; (2) dispatch through activation of the emergency medical service (EMS) system and prompt EMS response; (3) delivery of the victim to the receiving hospital while providing appropriate prehospital assessment and care and prearrival notification; (4) door—ED triage; (5) data—ED evaluation, including head computed tomography (CT) scan; (6) decision about potential therapies; and (7) drug therapy.

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    • Cited by (2)

    • Emergency Department Evaluation and Management of Stroke: Acute Assessment, Stroke Teams and Care Pathways

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      Citation Excerpt :

      In acute stroke management the adage is “time is brain” as delays in diagnosis and treatment may render the patient neurologically impaired and disabled. Promptly implementing the “Stroke Chain of Survival” (seven Ds) (Box 1) [7–9] heightens the likelihood of early presentation and acute treatment of the ischemic or hemorrhagic stroke patient. An American Heart Association/American Stroke Association (AHA/ASA) policy statement emphasizes the implementation of EMS within stroke systems of care [10].

    • Acute systemic erythropoietin therapy to reduce delayed ischemic deficits following aneurysmal subarachnoid hemorrhage: A Phase II randomized, double-blind, placebo-controlled trial: Clinical article

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