Ischemic Stroke – Acute

Direct transfer of an acute CVA patient from the ER to ANMC should always be considered as these patients have better chance at rehab as the rehab-queue for Alaska Regional starts at ANMC inpatient.

That being said, non-hemorrhagic, non-brain stem and stable stroke patients can be monitored inpatient for 1-2 days to assure there is no clinical worsening. On a cardiac-respiratory monitor emboli-producing arrhythmias can be screened while Physical Therapy can help assess for rehabilitation potential and ability to swallow can be grossly assessed.

Neurology and/or IM at ANMC should be consulted and the patient transferred there if rehabilitation is a possibility. YKHC inpatients can only go to rehab via ANMC inpatient. Otherwise, YKHC patients are discharged home with an ANMC IM follow-up appointment for an MRI, echocardiogram and carotid duplex (if latter not done in Bethel).

• We do give lytics for acute stroke if appropriate and no contraindications. Neurology at ANMC must be consulted if you are considering lytics.
• All acute strokes and TIAs are medevac’d to ANMC for further workup. This is true even if they have recovered from a neuro standpoint.

Resources/References

• Acute Ischemic Stroke YKHC Clinical Guideline
• Stroke RMT Guide
• Alaska Stroke Systems of Care (PowerPoint Presentation)

YKHC Clinical Guidelines
Common/Unique Medical Diagnoses