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Emergency Stroke Services

  • Medications used to the dissolve blood clot(s) that cause an ischemic stroke. Medications that dissolve clots are called thrombolytics or fibrinolytics are commonly known as "clot busters” and can help reduce the damage to brain cells caused by the stroke. By dissolving the clot, blood flow to the brain is restored, and can decrease the severity of symptoms. In order to be most effective and safe, these agents must be given within 4.5 hours of a stroke's onset.


  • Endovascular techniques used to dissolve or remove blood clot(s) that cause an ischemic stroke. Clot buster medications can be given directly at the clot using intra-arterial (IA) techniques. Patients that can be treated with these techniques must meet specific criteria using MRI imaging. This therapy can be used after the time window for intravenous therapy has passed, provided that criteria are met. Clot retrieval devices can be used in conjunction with IA therapy to remove clots from the brain and restore blood flow.


  • Brain Attack Team (BAT calls)- The Brain Attack Team responds to emergent patients suspected of having a stroke, and includes the stroke attending, stroke fellow, and neurology residents. When a patient presents to the emergency room with stroke symptoms with a time of onset within 12 hours, a BAT call is activated and a member of the Brain Attack Team will arrive to evaluate the patient within 15 minutes of arrival. A BAT call can also be activated by EMS before the patient is brought to the hospital to expedite patient care. A member of the BAT team will follow the patient through evaluation, diagnostic testing, and emergency treatment and through transfer to a Neurology floor, and will evaluate changes in neurologic exam throughout the process. The Brain Attack Team allows for efficient care of stroke patients through fast response, increasing the likelihood that emergency treatments can be given in time to reduce the effects of the stroke.


  • Diagnostic testing- With the opening of the new Emergency Department in 2012, we have increased access to diagnostic machines and tests. Most stroke patients now receive an MRI as their first diagnostic test, which allows us to better evaluate the presence, location, and severity of a stroke. Neurologists can make more informed decisions about emergency treatment. MRI is now available 24/7 to patients in the Emergency Department. Other diagnostic tests can also be obtained for emergency treatment such as Intra-arterial tPA.


  • Swallow screening for dysphagia before eating or drinking- Stroke patients are at risk for having difficulties swallowing (dysphagia), and all patients suspected of having a stroke are restricted from having oral intake until a swallow screen can be performed. If a patient with dysphagia has oral intake, they are at risk for aspirating, which is a serious complication.


  • NIHSS NIH stroke scale measures severity of stroke- Patients with stroke symptoms are evaluated with the National Institution of Health Stroke Scale(NIHSS) in the Emergency Department to determine the severity of their stroke. This test is the standard evaluation for all stroke patients, and is a quick way of communicating information about a patient’s condition to other providers. It is also used to evaluate changes in neurologic status throughout admission to the hospital.


  • Vascular neurosurgical and neurointerventional procedures for patients with stroke. Depending on the type of stroke and the cause, different procedures may be necessary, and may include endovascular coiling for brain aneurysms, hemicraniectomy, and surgery to repair aneurysms and arteriovenous malformations (AVMs).


  • Management of Increased Intracranial Pressure (ICP)- ICP can increase after stroke, and the brain is at risk for further damage through herniation. There are several interventions that can be used to manage increased ICP including special types of intravenous (IV) fluids like hypertonic saline, or changes in breathing through intubation and hyperventilation. ICP can be monitored and managed with an intraventricular catheter, which is inserted directly into the brain.

For more information, contact The Johns Hopkins Hospital Stroke Center at 410-955-2228.
If you have questions about the Stroke Prevention And Recovery Center, please call us at 443-287-8514.

 

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