Saudi Stroke Standards

Transfer of care). Stroke physician consultation via tele-stroke. Stroke Rehabilitation Care Pathway Hospital setting Community setting Acute Stroke Unit Acute Stroke Rehabilitation Inpatient Stroke Rehabilitation Stroke Rehabilitation OPD Spasticity management OPD Acute Stroke Care in Community Day care or OPD (PT, OT, SLP) Community services and Rehabilitation. Social Re-integration, Education, Vocational and family support Different levels of stroke expertise may be needed at the ASRH ranging from diagnosis to management. Live, synchronous videoconferencing with access to the ASRH picture archiving system (PACS) is standard practice. The use or tele-stroke and decision for IV r-tPA for selected acute ischemic stroke patients, should be standardized and be part of the protocol. In rural areas, if the distance from the nearest Primary or Comprehensive Stroke Hospital is more than 60 km, the use of tele-stroke and the ship and drip method is preferred. Within city limits, tele-stroke should be available if IV r-tPA may be delayed for more than 20 minutes. Emergency management services (EMS) EMS should be available 24 hours a day for immediate transfer of acute stroke patients to PSHs or CSHs. Acute management protocols during the transfer should be available and will include communication strategies, acute blood pressure management, oxygenation, hydration and swallowing protocols. Laboratory services Basic laboratory testing, including blood glucose, complete blood count, chemistry studies, coagulation profile, pregnancy testing, toxicology, and ECG will be available in the ASRH on an immediate basis and reported within 45 minutes. Radiology Emergency CAT scan of the brain should be available and done within 20 minutes of arrival in the emergency room. CAT scans should be read within 10 minutes of completion of the CAT scan. If indicated, CT angiogram (arch to vertex) should be performed on selected acute ischemic stroke patients after IV r-tPA is given. CT perfusion scanning may be considered in selected acute ischemic stroke patients within 24 hours of symptom onset. MRI and MRA may be used as a substitute for CAT and CTA, if they can be done in a timely fashion. Pharmacy Medications for the acute management of hypertension, hyperglycemia, hypoglycemia, seizures and coagulopathies should be readily available in the emergency department. Intravenous thrombolytics (IV r-tPA) should be quickly available. Sublingual nifedipine should NOT be given to manage acute hypertension in stroke patients. Transfers Predetermined written transfer protocols to PSHs and CSHs should be available and based on written agreements. Repatriation agreements should also be included.