Clip these guidelines for treating stroke patients

Physicians may be compared to airline pilots, rugged individuals whose experience and skills make them particularly suited for a highly stressful career in which they routinely hold people's lives in their hands. Yet unlike pilots, physicians often are too reluctant to loose control of the mundane details of their jobs, says Lawrence M. Brass, MD, professor of neurology at Yale University in New Haven, CT.

Brass asserts that this possessive control might prevent some physicians from providing new stroke patients with the most efficient care. Rather than physicians spending time making decisions that could be made automatically, they could concentrate on educating a patient about the disease and how to improve their health.

Too many physicians believe it takes away from their expertise to have certain treatments and tests done automatically, but that's not necessarily the case, Brass says. "It frees you up," he adds. "It's the mundane, routine aspects of patient care that should be taken away and done automatically because I expect that they need to be done."

Likewise, he says, physicians treating people who have just had an acute ischemic stroke will achieve better clinical outcomes if they follow these five guidelines routinely:

1. Patients should be started on some form of antiplatelet or anticoagulation therapy unless there's a clear contraindication.

2. Patients with carotid territory strokes should be evaluated for carotid narrowing if they are a surgical candidate. "That reduces the risk of a stroke by two-thirds," Brass says. "If they're not appropriate for surgery, then you don't need to do it."

3. All patients should have an EKG to evaluate heart rhythms and to monitor for arrhythmia, such as atrial fibrillation.

4. All patients with a new stroke should have some form of brain imaging, either a CT or MRI scan, to determine the nature of the stroke.

5. Blood pressure elevations usually do not need to be treated within a couple of days after a stroke, and any treatment should follow the guidelines of the American Heart Association in Dallas.