Ischemic Stroke – Acute

Generally speaking, all acute CVA patients should be transferred from ER to ANMC for full stroke workup and better access to consistent PT/OT/SLP.

Patients who decline transfer, particularly those without hemorrhage who have returned to neurologic baseline, could be monitored for 1-2 days at YKHC to monitor for worsening, screen for arrhythmia on telemetry, and work with our physical therapy colleagues. These patients should then be referred to ANMC neurology for MRI, echo, and carotid imaging (if not done in Bethel).

Resources/References

• Acute Ischemic Stroke YKHC Clinical Guideline
• Stroke RMT Guide
• iScore
• Siket Matt, Marcolini Evadne, Ganti Latha. Transient Ischemic Attack and Acute Ischemic Stroke. In: Mattu A and Swadron S, ed. CorePendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/recEAr4nPXQE4eOBH/Transient-Ischemic-Attack-and-Acute-Ischemic-Stroke.
• Emberson J et al.; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266.
• Alaska Stroke Systems of Care (PowerPoint Presentation)

YKHC Clinical Guidelines
Common/Unique Medical Diagnoses