Tuesday, September 20, 2011

Resources for Acute Stroke evaluation and treatment

This post is really just for me - so I can find a few certain documents without frantic Googling when the 3 hour clock is ticking...

AHA/ASA - Guidelines for the Early Management of Adults With Ischemic Stroke

 ACEP - Use of IV tPA for the Management of Acute Stroke in the ED


AHA/ASA Science Advisory - Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator (del Zoppo)

ECASS III Exclusion Criteria 
http://crashingpatient.com/medicine-surgery/095-stroke.htm  
Expansion of TPA window to 4.5 hours by AHA (Stroke 2009;40:) - ECASS III
  • Age < 18 or > 80 years
  • Onset of stroke > 4.5 hours before drug administration or symptom onset unknown
  • Stroke symptoms present < 30 minutes or significantly improving before treatment
  • Intracranial hemorrhage
  • Severe stroke as defined by NIHSS > 25 or imaging (CT or MRI) displaying > 1/3 of middle cerebral artery territory involved
  • Seizure at the onset of stroke
  • --------
  • Stroke or serious head trauma within the previous 3-months 
  • Major surgery or severe trauma within 3-months
  • Combination of previous stroke and diabetes mellitus
  • --------
  • SBP > 185 mm Hg or DBP > 110 mm Hg or IV treatment to reduce BP to these limits
  • Glucose < 50 mg/dL or > 400 mg/dL
  • Symptoms suggestive of subarachnoid hemorrhage even if CT normal
  •  -------
  • Heparin within the preceding 48 hours with PTT above normal limit
  • Platelet count < 100,000 mm3
  • Oral anticoagulation therapy (EVEN IF INR WNL)
  • Other major disorders with an increased risk of bleeding


www.aaem.org/education/tpaedtool-AAEM.pdf

22 comments:

  1. That AAEM guide is about the best risk-benefit publication I've ever seen. I've used it three times, and never pushed tPA. I wish we had more handouts like that...

    ReplyDelete
    Replies
    1. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David
      Clara I’m a citizen of USA, My younger sister was sicking of
      breast cancer and her name is David Sandra I and my family have taking her
      to all kind of hospital in USA still yet no good result. I decided to go to
      the internet and search for cancer cure so that was how I find a lady
      called peter Lizzy she was testifies to the world about the goodness of a
      herbal man who has the root and half to cure all kind of disease and the
      herbal man email was there. So I decided to contact the herbal man for my
      younger sister help tHe estado afectado por cáncer durante muchos años. Necesito curarme ahora.o cure her breast cancer. I contacted him and told him
      my problem he told me that I should not worry that my sister cancer will be
      cure, he told me that there is a medicine that he is going to give me that
      I will cook it and give it to my sister to drink for one week, so I ask how
      can I receive the cure that I am in USA, he told me

      That I will pay for the delivery service. The courier service can
      transport it to me so he told me the amount I will pay, so my dad paid for
      the delivery fee. two days later I receive the cure from the courier
      service so I used it as the herbal man instructed me to, before the week
      complete my sister cancer was healed and it was like a dream to me not
      knowing that it was physical I and my family were very happy about the
      miracle of Doctor so my dad wanted to pay him 5 million us dollars the
      herbal man did not accept the offer from my dad, but I don't know why he
      didn't accept the offer, he only say that I should tell the world about him
      and his miracle he perform so am now here to tell the world about him if
      you or your relative is having any kind of disease that you can't get from
      the hospital please contact dr.sakuraspellalter@gmail.com or whatsapp him
      +2348110114739 for the cure, he will help you out with the
      problem. And if you need more information about the doctor you can mail me
      davidclara223@gmail.com or whatsApp me +1(209)2621918

      Delete
  2. Educate the patient and family, know the inclusion and exclusion criteriae, and avoid the tPA hype!

    ReplyDelete
  3. I'm writing to express my profound gratitude to great spiritual doctor i have ever met who has healed me from stroke, I have been stroke down for over 3 years and I suffer so badly for years to an extent my marriage was broken, I meant with different doctors but no one was able to cure my stroke and some of these doctor told me that there's no cure for stroke which i almost believe them but I never knew that doctor muzack is going to prove them wrong which he actually did, i never know doctor muzack but a friend of mine recommended him to me, I found out he was an online spiritual doctor, i contact him directly on his email address tradomedicalhealer@gmail.com, I told him my problems, he told me what to do, which i did and he prepared herbal products and send it over to me here in my country, i took it as he directed for just four days, it was a miracle, I was heal from stroke and I'm even stronger than ever. I know that there are so many people who are passing through different types of sickness and pain try to give doctor muzack a trial, if he responds to you then know that's your problems has come to an end, his contact info +2347037791346,,, tradomedicalhealer@gmail.com

    ReplyDelete
  4. God have been very kind to me, despite the hard times he made me go through but now I give him all the praise for relieving my mum of her stroke through the help of an herbal doctor by name Uwadia Amenifo. Helen Smith is my name, and we live in England. My mum was diagnosed of stroke eight months ago, and she was in so many pains as she can’t even walk, go to rest room, or move her body. She even has to excrete in her body most times. I am her only child, and I so much love my mum because my dad died when I was 4 years old. So I grew up in the hands of only my mum without fatherly care. It happened that when she was diagnosed of stroke by our family doctor her condition was still good by then, but in just one month after her diagnoses, her condition became very worst that the doctor then said her stroke is acute and no longer partial. And that it will only take God’s intervention for her to be well again and for her to be able to retain the full use of her brain. So her ailment continues until God intervened before God’s intervention, I have carried her to so many churches for prayers and have traveled very far to look for a cure for her. I Travelled to America to see some doctors if they can help even if its surgery they can carry out on her provided she don’t die, because I really needed her around me. It was in America an Endocrinologist by name Jill Marie Abelseth MD from Albany, NY told me about an herbal doctor who she knows of, that have successfully cured stroke/ human parasites. So she advised me to contact the herbalist, so I contacted him, and explained to him what my mum is going through, so he counseled us and asked few questions about my mum which I told him. So he prepared the herbs, and shipped it to me in England. I gave my mum the herbs just as he has instructed, and just exactly as he said that his herbs will totally cure my mum. His herbs really worked perfectly well, and cured my mum. As I write this testimony my mum is totally cured of her stroke and she has started her normal business as usual. So I want all here to help me thank Doctor Uwadia Amenifo for his great help in helping me cure my mum of her stroke with his herbal medicine. Please if you know of anyone who have stroke or who have one disease or the other and his/her doctor says there’s no cure to that disease please I want that person to contact doctor Uwadia Amenifo, and give him a try. His contacts are Email (doctoruwadiaamenifo@gmail.com) his number is (+2349052015874), Thanks.

    ReplyDelete
  5. This information will greatly help the stroke patients, I suffered a massive ischemic stroke, I was forced to give up work after having a stroke, but the medication I used proved there is life after stroke and decide to share my testimony. It is a misconception that strokes can not be cured or reversed as stated by professionals. I am living proof that improvement and cure is certain with Herbal Medicine, death from stroke can be defeated. When I had the stroke, I felt trapped inside my body. I knew that everything that was 'me' was still there, but I couldn't communicate. It was the hardest thing I’ve ever gone through. With the Herbal Medicine, and his recommended healthy diet, I consider myself regaining as much as 99.9% back to my old normal and satisfied. It is in short, an answer to prayer. I'd recommend any stroke patient to contact Dr. Allen for advice and more information with email:drallenchase@gmail.com

    ReplyDelete
  6. ALL THANKS TO DR WILLIAMS FOR THE GREAT DEED HE HAVE DON FOR MY FAMILY.This information will be useful for Epilepsy and stroke patients who is willing to use herbal medicine. My daughter had temporal lobe epilepsy, She had seizure and had a grand mal with rage episode. Our daughter's seizure is constant throughout the day. We had used several medicine which include: Epilim and Keppra, experience seizure control at the cost of serious debilitating side effects. It was during a casual conversation with a friend that I learned about herbal Dr. William on how he help her cure his son from stroke,his medicine does not have any side effect. I am glad to say that he has been seizure-free since July 2015 after taking William medicine. this a miracle cure?contact him for more detail (drwilliams098765@gmail.com)

    ReplyDelete
  7. I am Sophie from Canada, I once suffered from a terrible and Chronic epilepsy ,since i was bone , the doctor told me there was no permanent cure i was given medications to slow down its progress, i constantly felt my health was deteriorating as i constantly go out of breath,and this illness was really terrible especially when am going out with my friends, i have this constant disorder for about 31 years, this was really a terrible illness ,on thin one day that i was going through the internet,and i came across a post of Mrs Kate on how his son was been cured from epilepsy through the help of Dr Williams herbal product, I contacted this herbal doctor via his email and explain everything to him and make purchase of his product,few days later he sent me the herbal medicine through courier service, when i received the herbal medicine i used it for 4 weeks as prescribed and i was totally cured of epilepsy within those week of usage,on thin now i have not experience any sign of seizure.if you need his help you can Contact this herbal doctor via his email drwilliams098675@gmail.com for help

    ReplyDelete
  8. ALL THANKS TO DR WILLIAMS FOR THE GREAT DEED HE HAVE DON FOR MY FAMILY.This information will be useful for Epilepsy patients who is willing to use herbal medicine. My daughter had temporal lobe epilepsy, She had seizure and had a grand mal with rage episode. Our daughter's seizure is constant throughout the day. We had used several medicine which include: Epilim and Keppra, experience seizure control at the cost of serious debilitating side effects. It was during a casual conversation with a friend that I learned about herbal Dr. William,who uses herbal medicine in curing people from epilepsy,i was so glad to contact him on his email and make an order for his medication, it does not have any side effect. I am so glad to say that she has been seizure-free since July 2015 after taking William medicine. this a miracle cure?contact him for more detail (drwilliams098675@gmail.com) thanks once again admin for such an informative blog.

    ReplyDelete
  9. (HOW MY WIFE WAS CURED FROM STROKE)
    My wife of 43 years of age got cured from stroke, she was diagnosed at the age of 37 and he have been on a sick bed for some years, she recently got cured with natural herbal treatment from Dr Ejmen the traditional herbalist healer. I'm so happy that my wife can live a normal life with me again after many years she suffered from stroke all thanks to Dr Ejmen my wife is now free from this deadly disease called stroke, if you are passing through the same problem you can contact him via his email you should know about his natural herbal treatment, Dr Ejmen email is been attached to my post reach him for help. drejmencurehome@gmail.com ‎ his contact number +2349061828381

    ReplyDelete
  10. My husband left me with 3 Children and went to stay with his Mistress whom i felt use a spell on him, I felt like ending it all, i almost committed suicide because he left us with nothing, i was emotionally down. But all thanks goes to Baba Alika, who i met online on one faithful day, as I was searching for tips to get my husband back home, I came across several testimonies about this particular man. Some people testified that he brought their Ex lover back, some testified that he help them to get pregnant,cure herpes simplex virus,and other sickness, and some testified that he prayed to stop divorce. He is amazing, i also come across one particular testimony, it was about a woman called Angeline, she testified about how he brought back her Ex lover in less than 2 days, and at the end of her testimony she dropped his email (babaalikahealinghome@gmail.com) After reading all these testimonies, I decided to give it a try. I contacted him and explained my problem to him. In just 48 hours, my husband came back to me. We resolved our issues, and we are even happier than ever. Baba Alika you are a gifted man and thank you for everything you had done in my life. If you have a problem and you are looking for a real and genuine spell caster, Try him anytime, he is the answer to your problems. you can contact him on email: babaalikahealinghome@gmail.com. he will surely help you solve your problem.

    ReplyDelete
  11. SAY NO TO AUTISM. I'm so happy today because of the wounder Dr Biodun has done with his autism herbal remedy in curing my 4 years old autistic son, it was hell for me to take good care of him because he always irritates me and i wished i never had him as a child back then he always wee on his body, eyes not straight, deaf so much more i was terrified and put all my hope in God because i have used so many hospital medications but to no avail. until this day when i was online in search of autism treatment for kids, there was a testimony of a woman testifying on how her autistic daughter was cured with the herbs of Dr Biodun i quickly massage the email address she dropped in the testimony (biodunherbal@yahoo.com) and i got a reply from Dr Biodun then i explained to him and he sent me his autism herbal medicine and gave me instructions on how to apply it on my son which i did as he commanded. Behold i watch my son changing gradually day by day while using the herbal cure on him, his voice became clearer, began to see and identify colours, making sentences and a lot of changes occurred, and i never believed that one day my son would be healed from autism embarrassment. contact him today don't be left out there is no harm in trying, believe me or not autism has a cure it is real am a living witness.

    ReplyDelete
  12. We are really grateful for your blog post. You will find a lot of approaches after visiting your post.
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    ReplyDelete
  13. I never thought I'd be writing this message but after 4.5 years of and nearly lost my marriage due to not be able to have a child, severe endometriosis and scanning, I was told that IVF was the only option. This was something we could not afford and had almost given up hope of becoming parents. A friend of mine recommended Priest Babaka to me and persuaded me to contact him, he did a spiritual breakthrough for me to make me get pregnant, within 3 weeks I was pregnant (naturally!!!) and gave birth to our son in April. I am writing this message for those women who are at the stage I was at.depressed with no light at the end of the tunnel. give Priest Babaka a try to help you solve your problem, and hopefully you'll have the same success that I have had. Here is his email address babaka.wolf@gmail.com or Facebook at priestly.babaka wish you all happiness in your marriage

    ReplyDelete
  14. I never thought I'd be writing this message but after 4.5 years of and nearly lost my marriage due to not be able to have a child, severe endometriosis and scanning, I was told that IVF was the only option. This was something we could not afford and had almost given up hope of becoming parents. A friend of mine recommended Priest Babaka to me and persuaded me to contact him, he did a spiritual breakthrough for me to make me get pregnant, within 3 weeks I was pregnant (naturally!!!) and gave birth to our son in April. I am writing this message for those women who are at the stage I was at.depressed with no light at the end of the tunnel. give Priest Babaka a try to help you solve your problem, and hopefully you'll have the same success that I have had. Here is his email address babaka.wolf@gmail.com or Facebook at priestly.babaka wish you all happiness in your marriage

    ReplyDelete
  15. Hello not used to putting things on websites, so bear with me. I Saw Dr. Otor of via: otorspelltemple@gmail.com address in a magazine, had to leave him a message as he didnt answer the phone first time, as soon as I heard his voice on the phone when he phoned me back, I knew this was a Man I could totally rely on and trust. And I was highly troubled as I was infected with herpes and it broke me down and I became very sad and worried. I needed help so badly that I was ready to do anything to cure my life. So I briefly explained my situation to him and he took all the details and began working for me. I was very skeptical at same time because I had never done anything like this in my life. I was very happy he kept in contact with me and answered me anytime I needed his attention and within a few days later I got my self cured and all my problems were put right by this wonderful Dr. Otor of via: otorspelltemple@gmail.com If you are facing difficulties I would advise you to contact Dr. Otor of via: otorspelltemple@gmail.com and get all your PROBLEMS solved call or whatsapp him with +2348158847627

    ReplyDelete
  16. As a sign of gratitude for how my son was cured from autism, i decided to reach out to those still suffering from Autism spectrum. My son suffered autism for 7 years and 4 months, it was really tough and heartbreaking for me because he was my all and the symptoms were terrible, he always have difficulty with communication not verbal, and he always complain of poor eye contact, hurt his self, likes music so much. We tried various therapies prescribed by our neurologist but none could cure him. Not until a day when I searched for a cure online and i saw different testimonies of how people are thanking and praising Dr Alwan who has cured their autistic children and so many others with Fallopian tube blockage, infections and diseases problems, and they all left the email of the doctor who had the cure to autism . I never imagined autism has a natural cure but i have no other choice than to contact Dr Alwan and he assured me my son will be fine and then asked me to purchase his autism herbs which i did. Few days later I got the herbal medication he recommended and also gave me instructions and guild lines on how it used. Behold it was amazing, before 2 weeks time i began to see different changes on my son now is perfectly okay, even up till this moment he is so full of life. Autism has a cure and it is an herbal cure contact the doctor for more info on (alwansolution@yahoo.com) on how to get cured of your autistic child. Thanks for reading my testimony.

    ReplyDelete
  17. Hello viewer my names are Nora Keith from Moline USA. I can’t believe this. A great testimony that i must share to all Cancer patient in the world i never believed that there could be any complete cure for CANCER. Last 2 weeks as i was online searching for a med for my cancer illness i saw people’s testimony on blog sites of how Baba Alika herbs and seeds oil cure for cancer brought them back to life again i had to try it too because i have been through a lot trying to be freed from cancer and you can't believe that in just few weeks i started using the oil after receiving it from Baba Alika through the dhl services, all my pains stop gradually. Right now i can tell you that i am completely cured from the cancer I have been suffering from for many years now. delay in treatment leads to death. contact the great Baba alika on his email:babaalikahealinghome@gmail.com or you can also reach him through his WhatsApp number +2347037748198 for his herbs and seeds oil cure for all kinds of cancer thanks.

    ReplyDelete
  18. This comment has been removed by the author.

    ReplyDelete
  19. Hello viewers my names are Nora Keith from United Kingdom. Baba Alika spiritual prayers and herbs seed oils have been incredible for my son. He has just tried Baba Alika spiritual prayers, herbs and seed oil and they seem to work best together. Before he was the extremely aggressive type, he was self abusive, non communicative and would meltdown over 7 hours a day. We hardly ever slept. he was still a big handful. Not until i saw so many amazing testimonies of different people praising and thanking Baba Alika online when i was searching for cure to Autism. Quickly i contacted Baba Alika and explained to him my son autism condition and he told me to purchased his herbs and seed oil which i had no other choice but to give a try, days later i received Baba Alika herbs and seed oil through DhL courier delivery service along with instructions on how it's used. Surprisingly in just few days later i noticed changes in my Son, he no longer screams all day like a banshee and he hasn’t been sent home from school in 3 weeks, which is just amazing. Before the oil he would only get 2 or 3 days at school each week because of his behavior. He would scream till 2am every night. His very first day on Baba Alika spiritual prayers and herbs and seed oils he quietly watched TV and went to bed at 10 with no prompting. I broke down and cried at this. I have suffered so much. He is doing great now and i am proud of him. His father is happy now, back then i used to blame God for such a useless son, but now everyone in the family is happy for what Baba Alika has done in the life of my family. If you have similar condition i will advice you contact his email: (babaalikahealinghome@gmail.com).

    ReplyDelete
  20. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David
    Clara I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is David Sandra I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the root and half to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man for my
    younger sister help tHe estado afectado por cáncer durante muchos años. Necesito curarme ahora.o cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me

    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whatsapp him
    +2348110114739 for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com or whatsApp me +1(209)2621918

    ReplyDelete
  21. Herbal supplements have existed for thousands of years and can be traced during several different cultures. As for now. Herbs are now used to cure Diabetic Herpes, Chronic Pain, Asthma Regurgitation, Chest Pain, Nausea, Dysphagia, Hiccups, even Sore Throat and Heartburn. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured of Sore Throat and Heartburn disease last year with the use of herbs and super soap, i suffered from Sore Throat and Heartburn for 13 years but with the help of DR. OSAS herbal medicine, i was cured within few weeks of using the herbs and super soap which he sent to me through DHL delivery service. I don't know the kind of health problem you are facing right now but i assured you that you will be cure if you contact Dr. OSAS and explain your problem to him, that issues will be solve within few weeks, Contact Dr OSAS through his Email address: drosasherbalhome@gmail.com or WHATSAP/CALL him on +2349035428122. share the good works of Dr Osas and save others lives from different kind of infections.

    ReplyDelete