Ischemic Stroke: A Case Study

Brown, Burton, Nazarian, and Promes (2015) along with the Agency for Healthcare Research and Quality (AHRQ) provides guidelines that support the use of t-PA for the management of acute ischemic stroke. The guidelines are based on their own reviews of evidence based studies to collect information to generate the guidelines. The objective of this study was to answer the question is t-PA safe and effective for patients with ischemic stroke if given within 3 hours of onset and also if given between 3-4.5 hours from onset. The methods used to collect the evidence were through hand-searches of published literature and searches of electronic databases. 195 articles were identified as relevant to review and analyze. Expert consensus was used to …show more content…
The ASA makes recommendations pertinent to the education of the general public, EMS and pre-hospital care, early management of the stroke patient in the hospital and on to supportive care during the patient’s hospital stay. It is the ASA’s recommendation that every eligible ischemic stroke patient receive t-PA. The goal is to administer the medicine within 45 minutes of the patient’s arrival to the ED. South Miami Hospital is a Primary Stroke Center which means that we are held to certain standards in order to achieve and maintain certification. According to The Joint Commission’s 2016 Certification Requirements for Primary Stroke Centers, t-PA needs to be administered within 45 minutes of patient arrival to the ED for 50% of the cases and within 60 minutes for 75% of the cases. Other requirements include: an Emergency Department Physician (EDP) must evaluate the patient within 10 minutes of arrival; the EDP must call the Stroke Neurologist on call within 15 minutes of arrival, CT scan of the brain must be completed within 25 minutes of arrival and read by the radiologist within 20 minutes of completion. Laboratory tests, EKG and chest x-ray, if ordered must be completed within 45 minutes of patient