The Code Stroke Handbook: Approach to the Acute Stroke Patient

by Andrew Micieli, Raed Joundi, Houman Khosravani, Julia Hopyan, David J. Gladstone

Overview

A 65-year-old patient arrives at the Emergency Department with stroke symptoms that began 45 minutes ago. You are called STAT!Acute stroke management has changed dramatically in recent years. Tremendous advances have been made in acute treatments, diagnostic neuroimaging, and organized systems of care, and are enabling better outcomes for patients. Stroke has evolved from a largely untreatable condition in the acute phase to a true medical emergency that is potentially treatable—and sometimes curable. The Code Stroke emergency response refers to a coordinated team-based approach to stroke patient care that requires rapid and accurate assessment, diagnosis, and treatment in an effort to save the brain and minimize permanent damage.The Code Stroke Handbook contains the "essentials" of acute stroke to help clinicians provide best practice patient care. Designed to assist frontline physicians, nurses, paramedics, and medical learners at different levels of training, this book highlights clinical pearls and pitfalls, guideline recommendations, and other high-yield information not readily available in standard textbooks. It is filled with practical tips to prepare you for the next stroke emergency and reduce the anxiety you may feel when the Code Stroke pager rings.

Product Details

ISBN-13:	9780128205228
Publisher:	Elsevier Science
Publication date:	05/27/2020
Pages:	238
Product dimensions:	4.38(w) x 7.38(h) x (d)

About the Author

Dr. Micieli completed his undergraduate degree and Business Master’s degree at the University of Toronto. He completed his medical school training at the University of Ottawa, and is currently a senior adult neurology resident at the University of Toronto. His research focuses on decision analytic models to evaluate the cost-effectiveness of health technologies, specifically in atrial fibrillation and intracranial hemorrhage. He is an aspiring stroke neurologist, and will be completing his stroke fellowship at the prestigious Calgary Stroke Program.

Dr. Joundi received his MD from Queen’s University and DPhil from Oxford University on a Rhodes Scholarship. He was co-chief neurology resident at the University of Toronto and is pursuing a stroke fellowship at the University of Calgary.

Dr. Khosravani is appointed as a Clinician in Quality & Innovation and Assistant Professor of Medicine, in the Division of Neurology, Department of Medicine, University of Toronto. His interests are quality improvement at different levels of care relevant to hyper-acute stroke management and inpatient stroke services. At the level of hyperacute stroke care, his focus is on improvement of door-to-needle times for thrombolysis. He is also working on understanding and improving factors that are relevant to a successful thrombectomy program in a comprehensive stroke center. He is medical director of the inpatient stroke unit, and interested in development of stroke pathways, the overlap between internal medicine and inpatient stroke neurology, and development of a framework for excellence in comprehensive neurovascular care. Dr. Khosravani is a member of Thrombosis Canada and interested in the implementation of stroke-best practices in the area of antithrombotics and anticoagulation. Dr. Khosravani also has a strong interest in utilizing computation and computer science to facilitate safe and high quality acute stroke care.

Dr. Hopyan is a stroke neurologist and Co-Director of the NeuroDoppler Laboratory at Sunnybrook Health Sciences Centre. She is also a clinician teacher with the University of Toronto and is actively engaged in undergraduate and postgraduate teaching as well as curriculum development in the field of stroke neurology. She runs a busy clinical practice and has interests in neurosonology and large vessel disease.

Dr. Gladstone is a stroke neurologist and Associate Professor of Medicine at the University of Toronto. Since 2004, his practice has been based at Toronto’s Sunnybrook Health Science Centre, a designated provincial Regional Stroke Centre, where he specializes in stroke diagnosis, emergency stroke treatment, and stroke prevention. As a clinician, Dr. Gladstone is regularly seen rushing into the hospital in the middle of the night to provide emergency consultations as part of the hospital’s “Code Stroke Team” and for the Ontario Telemedicine Network’s provincial Telestroke program. As a researcher, he leads clinical trials aimed at improving stroke management and outcomes. As a teacher, Dr. Gladstone enjoys training medical students, residents, international fellows, and other healthcare providers on best practices in stroke care.

Table of Contents

1. History Taking
2. Stroke Mimics
3. NIH Stroke Scale and Neurological Examination
4. Stroke Syndromes
5. Stroke Imaging: Noncontrast Head CT
6. Stroke Imaging: CT Angiography
7. Stroke Imaging: CT Perfusion
8. Acute Ischemic Stroke Treatment: Alteplase
9. Acute Ischemic Stroke Treatment: Endovascular Therapy
10. Basilar Artery Occlusion
11. Acute Stroke Treatment: Acute Blood Pressure Management and Anticoagulation Reversal
12. Acute Ischemic Stroke Treatment: Acute Antiplatelet Therapy

What People are Saying About This

From the Publisher

Comprehensive overview of acute stroke diagnosis, neuroimaging and acute stroke treatment

Editorial Reviews

Reviewer: Ali A Saherwala, MD (Thomas Jefferson University)
Description: This is the first edition of a clinical handbook for medical students, residents, and non-neurology practitioners on how to approach a patient with an acute stroke, focusing on initial assessment, diagnosis, and acute management.
Purpose: The purpose of this book is to provide a concise, handy guide accessible to non-neurologists who are involved in the acute management of stroke, written to provide the "essentials" of best care practices. It attempts to guide practitioners through the process of examining a patient for acute stroke, working through basic emergency neuroimaging, and discussing acute stroke treatment. It is written in a handbook format, meant for quick access and pocket-sized for portability. The authors meet these objectives nicely.
Audience: The intended audience includes medical students, residents before starting their neurology, emergency medicine, or internal medicine rotations, and other non-neurology practitioners involved in taking care of stroke patients. There is a careful attempt to keep the language accessible to non-neurologists, without compromising the delivery or scope of information. The authors are Canadian neurologists, making occasional references to Canadian guidelines, but the content is generalizable to all locations.
Features: This book is divided into three main parts. The first deals with the history and examination in approaching a patient with stroke symptoms, including extensive discussion of stroke mimics and the NIH Stroke Scale, along with neuroanatomical explanation of stroke syndromes. The second portion discusses neuroimaging with non-contrast head CT, CT angiography, and CT perfusion, providing numerous examples of various anterior and posterior circulation strokes. Finally, the last portion discusses acute stroke management with alteplase, endovascular therapy, blood pressure control, and antithrombotic therapies. Within each chapter there are numerous boxes containing practical case presentations highlighting the discussed topic, along with a quick summary at the end. There are numerous tables (albeit some with unusual formatting), helpful algorithms, and colored neuroanatomical and radiographic images that serve as instructive reference points for the discussed topic. Furthermore, there are references throughout the text noting evidence-based practices (CHANCE, POINT, etc.) as well as recent trials from the last few years (DEFUSE-3, EXTEND). It even touches on modifications needed during the SARS-CoV-2 (COVID-19) pandemic.
Assessment: This is a great introductory handbook detailing acute stroke care for those not as familiar with neurology or stroke, or for those who are not up to date with the most recent evidence. The numerous tables and figures summarize the information efficiently and make it a handy reference, yet its size and portability make it convenient to store in a white coat pocket. Given that stroke care is evolving rapidly, the references to tenecteplase, extended time windows, and CT perfusion help in keeping these practitioners aware of the latest guidelines. The book is especially valuable to those in the emergency room, internal medicine trainees, and medical students starting their neurology rotations. It is a worthwhile purchase for these non-neurologists and, given its accessibility and conciseness, it can be easily read quickly.

Doody's Review Service

"This is a great introductory handbook detailing acute stroke care for those not as familiar with neurology or stroke, or for those who are not up to date with the most recent evidence. The numerous tables and figures summarize the information efficiently and make it a handy reference, yet its size and portability make it convenient to store in a white coat pocket. Given that stroke care is evolving rapidly, the references to tenecteplase, extended time windows, and CT perfusion help in keeping these practitioners aware of the latest guidelines. The book is especially valuable to those in the emergency room, internal medicine trainees, and medical students starting their neurology rotations. It is a worthwhile purchase for these non-neurologists and, given its accessibility and conciseness, it can be easily read quickly." —Doody

From the Publisher