Hyperacute & Acute Care
Acute care is where the person is stabilized, diagnosis confirmed, plans are implemented to prevent complications, and when initial rehabilitation and recovery begin.
The period of time from when a person calls 911 to arrival to the Stroke Centre Emergency department is often referred to as the Hyperacute period. All patients with suspected acute stroke would receive rapid assessment and undergo brain imaging on arrival to determine eligibility for the intravenous drug tPA (tissue-plasminogen activator) also known as the “clot buster”. Administration of tPA soon after onset of symptoms can limit irreversible ischemic damage.
A new procedure: Endovascular Therapy (EVT) can sometimes be an option for patients with large artery ischemic strokes. There are 2 EVT centres in the Southwestern Ontario Stroke Network region that perform this specialized procedure: Windsor Regional Hospital – Oulette Site and London Health Sciences Centre – University Hospital. This procedure is available to appropriate candidates 24/7 at University Hospital. This youtube video shows how the procedure is performed: https://www.youtube.com/watch?v=0DQPD5TTS5Y
Patients with an acute stroke or transient ischemic attack would be admitted to a stroke centre and receive care on an inpatient stroke unit. A Stroke Unit is a geographically defined hospital unit dedicated to the management of stroke patients [Evidence Level A]. This unit is staffed by an interdisciplinary health care team who provide coordinated, best practice stroke care. Stroke patients who receive stroke unit care are more likely to survive, return home, and be independent than stroke patients who receive less organized, general ward care (Stroke Unit Trialists’ Collaboration 2009). Stroke Units can be classified as Acute, Integrated (combination of acute and rehabilitation stroke beds), or Rehabilitation Stroke Units.
- Windsor Regional Hospital – Oulette Site: Acute Stroke Unit
- Bluewaterhealth – Norman Site: Acute Stroke Unit
- Chatham Kent Health Alliance – Chatham Campus: Integrated Stroke Unit
- Grey Bruce Health Services – Owen Sound Site: Acute Stroke Unit
- Huron Perth Healthcare Alliance – Stratford General Hospital: Integrated Stroke Unit
- St. Thomas Elgin General Hospital: Integrated Stroke Unit
- London Health Sciences Centre – University Hospital: Hyperacute and Acute Stroke Units
- Approximately 80% of strokes are ischemic and 20% are hemorrhagic
- 55% of acute stroke patients have dysphagia in the first few days following a stroke
- Development of a Hyperacute Stroke Unit at London Health Sciences Centre, Regional Stroke Centre (2014 Canadian Stroke Congress)
- In-hospital Code Stroke Protocol Ensures Faster Access to Hyperacute Stroke Care (2015 Canadian Stroke Congress)
- tPA Nurse Role Impacts Hyperacute Stroke Care at University Hospital (2015 Canadian Stroke Congress)
- Building a Stroke Unit Toolkit…..A Phased-in Approach (2016 Canadian Stroke Congress)
EMS Newsletters featuring stroke articles:
Regional Stroke Acute Care Coordinator
Southwestern Ontario Stroke Network
University hospital, London, Ontario
519 685-8500 ext. 35268