Clinical Guidelines for Acute Stroke Management - Living on the EDge

Contents
PREFACE............................................................................................................................................................i
KEY MESSAGES................................................................................................................................................ii
INTRODUCTION................................................................................................................................................1
Setting the scene: a consumer perspective ....................................................................................................1
<strong>Acute</strong> stroke care............................................................................................................................................1
Australian <strong>Clinical</strong> <strong>Guidelines</strong> <strong>for</strong> <strong>Stroke</strong> <strong>Management</strong> ....................................................................................2
SECTION 1: ORGANISATION OF SERVICES ..................................................................................................6
1.1 <strong>Stroke</strong> unit care ........................................................................................................................................6
1.2 Organisation of services <strong>for</strong> transient ischaemic attack (TIA)......................................................................7
1.3 Organisation of care <strong>for</strong> rural centres ........................................................................................................8
1.4 Care pathways..........................................................................................................................................9
1.5 Inpatient care coordinator ......................................................................................................................10
1.6 Team meetings ......................................................................................................................................10
1.7 Family meetings......................................................................................................................................10
1.8 In<strong>for</strong>mation and education ......................................................................................................................11
1.9 Early supported discharge ......................................................................................................................11
1.10 Shared care ..........................................................................................................................................12
1.11 Standardised assessment ....................................................................................................................13
1.12 Palliation and death ..............................................................................................................................13
1.13 <strong>Stroke</strong> service improvement..................................................................................................................14
SECTION 2: PRE-HOSPITAL CARE ..............................................................................................................16
SECTION 3: EARLY ASSESSMENT & DIAGNOSIS........................................................................................17
3.1 Assessment of TIA..................................................................................................................................17
3.2 Triage in emergency department ............................................................................................................18
3.3 Imaging ..................................................................................................................................................19
3.4 Investigations..........................................................................................................................................20
SECTION 4: ACUTE MEDICAL AND SURGICAL MANAGEMENT ................................................................22
4.1 Ischaemic stroke and TIA........................................................................................................................22
4.1.1 Early management of TIA ................................................................................................................22
4.1.2 Thrombolysis ..................................................................................................................................22
4.1.3 Antithrombotic therapy ....................................................................................................................25
4.1.4 Blood pressure lowering therapy......................................................................................................25
4.1.5 Surgery <strong>for</strong> ischaemic stroke............................................................................................................26
4.2 Intracerebral haemorrhage (ICH) ............................................................................................................26
4.3 General acute stroke care ......................................................................................................................27
4.3.1 Physiological monitoring ..................................................................................................................27
4.3.2 Oxygen therapy ..............................................................................................................................28
4.3.3 Glycaemic control ............................................................................................................................28
4.3.4 Neuroprotective agents....................................................................................................................28
4.3.5 Complementary and alternative therapy ..........................................................................................29
SECTION 5: ASSESSMENT AND MANAGEMENT OF THE CONSEQUENCES OF STROKE ......................30
5.1 Dysphagia ..............................................................................................................................................30
5.2 Nutrition..................................................................................................................................................31
5.3 Early mobilisation ....................................................................................................................................32
5.4 Early therapy <strong>for</strong> difficulties with occupational per<strong>for</strong>mance in daily activities
(Activities of Daily <strong>Living</strong>, ADL) ................................................................................................................33
5.5 Cognition and perception........................................................................................................................34
5.6 Communication ......................................................................................................................................34
5.7 Incontinence ..........................................................................................................................................36
5.8 Mood......................................................................................................................................................37