Management of acute stroke. Specific nursing care and treatments in the stroke unit

OBJECTIVE

This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care.

METHODS

We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification.

RESULTS

The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital.

CONCLUSIONS

These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Management of acute stroke. Specific nursing care and treatments in the stroke unit

OBJECTIVE

This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care.

METHODS

We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification.

RESULTS

The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital.

CONCLUSIONS

These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Fecal Calprotectin in Ileal Crohn's Disease: Relationship with Magnetic Resonance Enterography and a Pathology Score

BACKGROUND

Magnetic resonance enterography (MRE) is an effective method of assessing small bowel Crohn's disease (CD). Fecal calprotectin (FC) correlates well with endoscopic disease activity. We aimed to evaluate the correlation between FC and disease activity according to MRE and surgical pathology in small bowel CD.

METHODS

One hundred twenty consecutive patients with ileal CD who underwent MRE assessment were included. Clinical data, C-reactive protein and FC, radiological and histological variables were obtained. Clinical activity was evaluated by the Harvey-Bradshaw Index and FC by enzyme-linked immunosorbent assay. MRE activity was assessed by means of the Magnetic Resonance Index of Activity score. Chiorean's score was used to grade pathological inflammation in surgical specimens.

RESULTS

Seventy-five patients (62.5%) were in clinical remission (Harvey-Bradshaw Index < 5) and 45 (37.5%) had active disease (Harvey-Bradshaw Index ≥ 5). The Magnetic Resonance Index of Activity score was significantly associated with FC levels (P < 0.01), with a moderate overall correlation (Spearman's r = 0.56, P < 0.001). FC reflected MRE inflammatory activity with an area under the receiver operating characteristic curve of 0.914 (confidence interval, 0.849-0.958; P < 0.001). A cutoff value of 166.50 μg/g had 90% sensitivity, 74% specificity, 89% positive predictive value, and 76% negative predictive value for diagnosis of inflammation. Twenty-eight of 120 patients were operated. Surgical pathology showed a good agreement with FC for moderate (P = 0.03) and severe (P = 0.01) Chiorean's index. No relationship was detected for C-reactive protein.

CONCLUSIONS

FC correlates with the degree of MRE inflammatory activity and with surgical pathology damage in ileal CD. Thus, FC could be a surrogate marker of disease control used to select patients for MRE assessment and therapeutic adjustment.

Fluid-attenuated inversion-recovery imaging of hemichorea

I report a young man with hemichorea in whom fluid-attenuated inversion-recovery images alone showed signal change.

[Hemarthrosis as a hemorrhagic complication after thrombolytic treatment]

Hemorrhage of variable severity is the main complication of thrombolytic treatment. We present the case of a rare hemorrhagic location after the use of this treatment for acute myocardial infarction, as ankle hemarthrosis. In the first twelve hours the patient had a joint hemorrhagic effusion with refractory pain and arthrocentesis was required. Recurrence occurred while receiving heparin and after discontinuation of heparin perfusion stopped the patient developed occlusion of the coronary artery related to the infarct requiring emergency angioplasty. We discuss the severity and possible treatment of this situation.

Fatal pulmonary embolization of a right atrial mass during transesophageal echocardiography

Transesophageal echocardiography is a semi-invasive diagnostic technique with a very low incidence of significant complications. Only two deaths related to the procedure have been reported in the literature. We present the case of a 46-year-old man with a right atrial mass, presumably a cardiac myxoma. During attempts at esophageal intubation for a transesophageal echocardiography procedure, the mass fragmented and dislodged, causing massive pulmonary embolism and death. We believe that to avoid this potential complication, great care must be taken in the evaluation of patients with a right intracardiac mass by means of transesophageal echocardiography.

Absence of left-sided predominance in asbestos-related pleural plaques: a CT study

STUDY OBJECTIVES

Differences between the number and areas of pleural plaques in every hemithorax could not be expected a priori. However, previous studies based on chest radiographs reported an unexplained left-sided predominance. In this paper, a comparison of summed surfaces and location of plaques calculated from CT studies was performed.

PATIENTS AND METHODS

Thoracic CT scans from 40 adults with asbestos exposure and pleural plaques were analyzed. The surface area of every plaque was calculated, and summed areas were recorded separately for every hemithorax. The statistical analysis was performed with t-tests for paired samples. Emphasis was placed on measurement differences.

MEASUREMENTS AND RESULTS

The results show lack of significant predominance for any hemithorax. A total of 668 plaques (352 right and 316 left) were measured, with an average area (+/-SD) of 47.81+/-47.72 cm2 for the right plaques and 45.34+/-67.32 cm2 for the left. The mean of differences (left minus right areas) was -2.56+/-53.68 and slightly statistically different from zero (p=0.652).

CONCLUSIONS

Left-sided predominance of asbestos-related pleural plaques is not supported by this study.

Multiple bile duct hamartomas: US, CT, and MR findings. A case report

We report ultrasound, CT and MR findings in a patient with multiple bile duct hamartomas (BDH) which were associated with disseminated peritoneal leiomyomatosis, a coincidence not previously reported. At MR imaging, the multiple hepatic nodules of BDH were hypointense in T1-weighted images and moderately hyperintense in T2-weighted images, which is in agreement with the findings in the 2 previously reported cases examined with this modality.