Acute Stroke Management
As per the Canadian Stroke Best Practice Recommendations – acute stroke management encompasses pre-hospital, emergency department and acute inpatient stroke care. Please refer to the Acute Stroke Management Update 2018 for further details.
The period of time from when a person calls 911 to arrival to the Stroke Centre Emergency department is often referred to as the Hyperacute period. All patients with suspected acute stroke should be screened immediately and undergo neurovascular imaging to determine their eligibility for both intravenous thrombolysis (within 4.5 hours of stroke symptom onset) and/or interventional treatment with endovascular thrombectomy (within a 6 hour window from stroke symptom onset).
“All patients with suspected ischemic stroke who arrive at 6-24 hours after stroke onset (late presentation and stroke on awakening with unknown onset time) and are potentially eligible for late window endovascular thrombectomy treatment should undergo immediate brain imaging with non-contrast CT with CTA and CT perfusion, or MRI with MRA and MRP [Evidence Level B].” Acute Stroke Management Update 2018
Large Vessel Occlusion Screening
The Ontario Paramedic Prompt Card for Acute Stroke Protocol now includes the addition of the Los Angeles Motor Scale (LAMS) to assist in identifying a large vessel occlusion (LVO). This changes takes effect January 11th, 2021. Training materials for the LAMS can be found on the CorHealth website. Click Here for further information.
Many of the Emergency Departments within CESN are implementing ACT-FAST as a screening tool for LVO. A toolkit has been developed to support training in ACT-FAST. Additional resources are available on the CorHealth website under Stroke Triage Education ACT-FAST.
CESN ACT-FAST Stroke Screening Algorithm (word doc)
CESN ACT-FAST Quiz (word doc)
On March 5th, 2020 CESN held a webinar for regional consultation regarding the “Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 6-24 Hours of Stroke Symptom Onset”
To view webinar CLICK HERE
Webinar slides are available in handout format – CLICK HERE
Patients with an acute stroke or transient ischemic attack would be admitted to a stroke centre and receive care on an inpatient stroke unit. A Stroke Unit is a geographically defined hospital unit dedicated to the management of stroke patients [Evidence Level A]. This unit is staffed by an interdisciplinary health care team who provide coordinated, best practice stroke care. Stroke patients who receive stroke unit care are more likely to survive, return home, and be independent than stroke patients who receive less organized, general ward care (Stroke Unit Trialists’ Collaboration 2009).
Telestroke is an emergency telemedicine application using videoconferencing technology. Telestroke sites can provide assessment and treatment of patients experiencing acute stroke via consultation with a provincial Telestroke neurologist. The neurologist can view the patient’s CT scan electronically, “see” the patient using live video and discuss results with the patient’s physician. In CESN currently 4 sites have access to Telestroke: Royal Victoria Regional Health Centre, Barrie; Muskoka Algonquin Health Centre, Huntsville; Peterborough Regional Health Centre; Peterborough; and Lakeridge Health, Oshawa.
Canadian Stroke Best Practice Recommendations – Virtual Healthcare (Telestroke) Implementation Toolkit 2020 – Click Here