Current Advances in Emergency Department Care of Acute Ischemic Stroke

Current Advances in Emergency Department Care of Acute Ischemic Stroke is organized by EB Medicine.

Date of Original Release: June 15, 2019
Date of most recent review: May 15, 2019
Termination date: June 15, 2022

Target Audience:
This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.

CME Credits:
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. 

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke CME and 2 Pharmacology CME credits, subject to your state and institutional approval.

Full Issue:
When acute ischemic stroke occurs, the patient’s outcome depends on rapid clearance of the thrombus. Two of the primary treatments for stroke are IV thrombolysis with alteplase (rt-PA) and thrombectomy via endovascular therapy (EVT). Time is brain. What do you choose?

• What are the latest guidelines on the time window for IV thrombolysis with rt-PA?
• What are the inclusion and exclusion criteria for administering rt-PA?
• Is the patient’s age a factor in deciding whether to administer rt-PA?
• What are the two major complications from IV thrombolysis, and how should you manage them?
• Can you perform EVT on a patient who has been given rt-PA? Should you?
• What are the circumstances when thrombectomy is a better choice than IV thrombolysis?
• How has the evidence for EVT evolved?
• What are the best uses of CT angiography and CT perfusion in assessing patients with acute ischemic stroke?

Goals: 
Upon completion of this activity, you should be able to: 
(1) demonstrate medical decision-making based on the strongest clinical evidence; 
(2) cost-effectively diagnose and treat the most critical presentations; and 
(3) describe the most common medicolegal pitfalls for each topic covered.

CME Objectives:
Upon completion of this article, you should be able to:
• Utilize the inclusion and exclusion criteria for initiation of intravenous thrombolysis
• Manage complications of intravenous thrombolysis based on the current guidelines and evidence
• Develop strategies for managing wake-up stroke
• Apply patient selection criteria for initiating endovascular therapy
• Choose appropriate imaging modalities to guide treatment with endovascular therapy
• Utilize devices and equipment for endovascular therapy.