Pre-Conference Symposium focuses on stroke treatment in the ED

“ISC Pre-Conference Symposium I: Stroke in the Real World: Emergency Stroke Care 2014” on Feb. 11 is designed to provide up-to-date information highlighting scientific advances in cerebrovascular disease while emphasizing their application in the real world.


Theodore Wein, MD, FRCPC, FAHA

“Our goal was to put together a comprehensive course for emergency department doctors so that they can maximally treat their acute stroke patients with the latest therapies, and interventions and improve outcomes. This not only includes medical management of patients but also exploring triaging of stroke patients and knowing when patients should be sent to comprehensive or primary stroke centers,” said Co-moderator Theodore Wein, MD, FRCPC, FAHA, assistant professor of neurology and neurosurgery at McGill University Health Centre in Montreal.

While this year’s symposium will focus on issues pertinent to the acute management of stroke in the emergency department, ED physicians as well as hospitalists, neurologists, nurses, nurse practitioners, physician assistants, stroke fellows and pharmacists will greatly benefit from the symposium.

“The program is geared for anyone who would treat acute stroke patients. There is a role for EMS to be there, and this is a great opportunity for hospital administrators and coordinators to see what needs to be done in their institutions,” Wein said. “It also will be beneficial for hospitalists, internists and family doctors who work in communities and deal with emergency settings, so they know how to triage their patients and make sure they get appropriate therapy at the appropriate center.”

The main focus will be on identifying unusual presentations of stroke; reviewing data on the use of intravenous and intra-arterial therapy; field triage of stroke patients and the utilization of primary stroke centers; treating intracerebral hemorrhage, subarachnoid hemorrhage and ischemic stroke during the golden hour in the ED; and managing complications of novel anticoagulants as well as a series of concurrent sessions. Participants will also have the opportunity to have an informal lunch with the faculty where questions or challenging stroke cases may be discussed.

“We’ve put together a great day. It covers all aspects of stroke care and is designed to be straight and to the point with clear take-home messages for each of the talks,” said Wein, whose co-moderator is Joshua Goldstein, MD, PhD, FAHA, associate professor of surgery at Harvard Medical School in Boston.

He pointed to a presentation on putting the ED in an ambulance. The speaker will present data on the effectiveness of using CT in an ambulance, which he has done in Germany.

“We want to give people an up to date look at what’s going on in the world, what we’re doing, what we can do better and perhaps what we should be doing. We’re using an international faculty to bring their experiences from around the world,” Wein said.

Two presentations — on intravenous thrombolysis in 2014 and decision analysis in thrombolytic therapy — will focus on the latest therapies.

“The reality is that the only treatment we have for acute stroke care that’s FDA approved is the use of intravenous TPA within the first four and a half hours after stroke,” Wein said. “The purpose of this program is to give the audience a clear-cut picture of where we stand in 2014, how people should proceed to administer these advanced therapies, and when to realize perhaps when patients should be considered for these therapies,” Wein said.

Beyond hearing 16 expert presentations, attendees can choose to participate in two of four concurrent sessions that will be offered on:

  • “The 5-Minute Neurological Exam”
  • “Dissecting Dizziness”
  • “Are You Up to Snuff? Current Standard of Care for Treating TIA and Stroke”
  • “Imaging and Thrombolysis Workshop”

“The concurrent sessions are designed to help people by going back to the basics. For example, I’ll speak on the 5-minute neurological exam. Many are worried about the neurological exam, and I think that a fairly compressive exam can be done in five minutes,” Wein said.

“All of these concurrent sessions are meant to be interactive workshops for people to make sure they’re performing as they should and are up to date on the latest guidelines.”

Ultimately, the day is devoted to improving systems, physicians and organizations in the care and management of stroke in the ED.

“We want to make people aware that there are therapies available for stroke outside of TPA and help them understand when to ask for these other therapies,” Wein said. “We want to ensure that they leave with a comprehensive knowledge of not only acute stroke care in the emergency room, but a systems approach on how to organize interactions with their EMS services and their tertiary or secondary stroke centers, and to help identify who they can treat in their centers, how they can order emergency services in their communities, and, most importantly, how they can decide who needs to go on to a different institution.”