Goals and Objectives
Goals
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Trainee will demonstrate competence in the initial evaluation and basic management of patients with stroke
Objectives
Trainee will be able to:
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Describe common presentations of acute ischemic and hemorrhagic strokes
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Accurately administer the National Institutes of Health Stroke Scale for patients with suspected ischemic stroke
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Describe anatomic distribution of ischemic cerebrovascular lesions based on neurologic deficits
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Describe an approach to stroke diagnosis in patients presenting with dizziness
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List risk factors for ischemic and hemorrhagic strokes
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List acute interventions for patients presenting with suspected or confirmed stroke and discuss their indications
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Airway management
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Glucose measurement / management
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Blood pressure management
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Anticoagulation reversal
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Thrombolysis
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Endovascular intervention
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Describe guidelines for administration of tPA including indications and contraindications
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Describe an approach to the bleeding patient who recently received tPA
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Discuss the indications for endovascular thrombectomy in ischemic stroke and emerging evidence for extended-window intervention
Additional Resources
​​Ischemic Stroke
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Ischemic Stroke (CDEM 2019)
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AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke (Stroke 2019) (pdf)
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tPA for Acute Ischemic Stroke (ACEP Clinical Policy 2015) (pdf)
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Extended Window Thrombectomy Literature
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Posterior Stroke
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Diagnosing Patients with Acute-Onset Persistent Dizziness (Ann Emerg Med 2018) (pdf)
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Posterior Strokes: A Wolf in Sheep's Clothing (ACEP Now 2019)
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Ischemic Posterior Circulation Stroke (Front Neurol 2014) (pdf)
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PV Card: Acute Vestibular Syndrome vs. Stroke (ALiEM 2011)
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Diagnosing Posterior Stroke (EMCrit 2010)
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Posterior Stroke Video (EMCrit 2010)
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iPhone for Head Impulse Testing (EMCrit 2010)
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Hemorrhagic Stroke
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Intracranial Hemorrhage (CDEM 2019)​
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Subarachnoid Hemorrhage​
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SAH Diagnosis and Management (WestJEM 2019)​ (pdf)
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Guidelines for the management of aneurysmal SAH (Stroke 2012) (pdf)
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Critical Care of Poor-Grade SAH (Curr Opin Cit Care 2011) (pdf)
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Anticoagulation Reversal
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Anticoagulation Reversal (Stroke 2019) (pdf)
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tPA-associated ICH
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tPA-associated Intracranial Hemorrhage (ACEP EQUAL 2020)​
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Consensus Statements
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AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke (Stroke 2019) (pdf)
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Transient Ischemic Attack (ACEP Clinical Policy 2016) (pdf)
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tPA for Acute Ischemic Stroke (ACEP Clinical Policy 2015) (pdf)
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Guidelines for the Management of Aneurysmal SAH (Stroke 2012) (pdf)
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Stroke Imaging
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Imaging for Acute Neurologic Conditions (EB Medicine 2007)