Prehospital stroke management

Abstract

Both the intravenous recombinant tissue plasminogen activator (IV rt–PA) and endovascular therapy (EVT) show new insights for hyper–acute stroke care. Prehospital stroke management plays an important role in conducting IV rt–PA and/or EVT immediately after stroke onset. Advertisements of stroke symptoms and adequate behavior for citizens is the first step for onset–to–call bypass. The first, and proper reaction of patients and bystanders at a stroke onset is essential in order to quickly reach the hospital. Public educational systems using TV programs should be recommended.

Secondarily, paramedics must use a prehospital stroke scale in order to establish better, direct transportation to a stroke center for on–set–to call stroke bypass. The requirements of prehospital stroke scales are sufficiently accurate straightforward enough for paramedics tasked with selecting stroke patients from mimic strokes.

Finally, it is important that we make an IV rt–PA/EVT bypass to shorten the interval between onset to treatment. Regarding IV rt–PA bypass, thrombolysis needs to be initiated onsite for a hyper–acute stroke patient. A mobile stroke unit and biomarker may be beneficial. EVT bypass is for a hyper–acute stroke patient with suspected large vessel occlusion (SPLVO) needs to be selectively and preferentially transported from onsite to a comprehensive stroke center. When SPLVO is admitted to a primary stroke center, expeditious transfer to a comprehensive stroke center should be conducted, or in the vernacular…, drip, ship, and retrieve.