Treatment Evolution for
Emergent Stroke Patients
by Mark Richmond, MD, FACEP
Medical Director, Emergency Medicine,
Santa Barbara Cottage Hospital
Emergency department stroke management along the central coast and inland regions has been truly revolutionized by the development of the comprehensive Stroke center at Santa Barbara cottage Hospital.
In the not-so-distant past, the approach to a patient with onset of stoke symptoms less than three hours from the time of presentation was complicated, arduous and anxiety-provoking.
Concerns included medical issues, such as "Will this patient develop an ICH?" And "is this therapy truly efficacious?" Process issues raised questions, including: "How can I get lab results and a CT scan of the brain completed and read within 45 minutes?" or "Who will assume medical care once the decision has been made to administer t-pA?" and "Will the patient receive proper nursing and ancillary care throughout his/her stay in the hospital and rehab facility?"
Medico-legal questions abounded as well, including concerns of being sued if a patient developed a complication from thrombolytic administration. even conspiracy theorists held sway that the drug companies had fabricated data to increase the use of an expensive medication.
During the last decade, our system has evolved in such a way that acute stroke patients are treated rapidly and efficiently by practitioners with experience in state-of- the-art modalities. the cornerstone of the comprehensive stroke center is the use of the stroke team.
When a possible stroke patient enters our system, either as a walk-in or via EMS, a stroke team-consisting of an emergency physician, stroke neurologist, internal medicine resident, specially trained nurses and ancillary staff-is immediately mobilized. each member of the team knows exactly what he or she needs to do to accomplish the team's immediate goal of administering thrombolytics to patients who may benefit from them.
A neurologist or neurosurgeon specializing in stroke care provides input crucial for individualizing care during the patient's stay. specially trained staff members, including representatives of all ancillary services, work to maintain the cottage commitment to comprehensive care through and beyond discharge.
From a medico-legal perspective, data on the administration of t-pA show emergency physicians are more likely to be sued for not administering thrombolytics than for giving them. Even the Canadian health system has determined that the administration of thrombolytics to appropriate patients results in improved outcomes and reduced overall cost to their medical system.