reverse is a significant medical e...

reverse is a significant medical enigma that affects more than 700000 Americans annually. (1) In the United States, it is the third leading cause of death, the major cause of disability, and the primary reason for nursing abiding-place admissions. (1,2) Because of the aging of the U population and the increasing incidence of chronic illnesses, the rate of attack and its associated costs will continue to escalate. Unfortunately, public awareness of the warning signs of blow and its early treatment remain limited. (34)

In this issue of American Family Physician, Ezekowitz and associates (5) review strategies that have been shown to be effective in thump prevention. It is clear that preventive measures and early interventions can restore the morbidity, mortality, and expense of stroke. Thus, physicians ne to recognize which patients are at risk for knock and design systematic approaches to these patients. (6) In addition, medical education lacks to focus on stroke prevention and the care of patients who experience a calamity (7)

Primary prevention of calamity includes the treatment of hypertension and hyperlipidemia, the use of angiotensin-converting enzyme inhibitors and grape-sugar control in patients with diabetes, the use of warfarin (Coumadin) in patients with atrial fibrillation, and smoking cessation. Weight reduction in obese patients and increased physical activity also should be encouraged. Low-dose aspirin has not been shown to be effective in preventing a first shock and, in fact, can increase the risk of hemorrhagic thump (8) Secondary prevention of blow may include the use of antiplatelet agents, aspirin, warfarin, statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors), and carotid surgery Treatment of chronic diseases as it was as hypertension and diabetes should succeed accepted evidence-based guidelines. (9,10)

The media (particularly television) and community-based education in settings similar as schools and churches can help to increase public awareness of the warning signs and early treatment of affliction (11,12) In addition, medical office personnel must be able to provide specific advice when a patient or family member calls to report signs suggestive of attack If there is a possibility that a patient could be having a pat "9-1-1" should be called immediately. Delay in treatment because the signs of pat were not recognized results in a poorer issue (13) The patient with a possible shock must be a top priority and should be transported to an appropriate facility at an emergency medical service, rather than at private car. (14)

Hospital unforeseen occasion departments should develop triage regularitys to care for patients who have signs consistent with attack (14) Triage should be similar to that in patients with chest pain who may have cardiac disease. agitation blood glucose levels, and vital fluid pressure must be managed, and consideration should be given to immediate administration of aspirin.

righteous evidence shows that patients with an ischemic blow who meet specific criteria benefit from the administration of tissue-type plasminogen activator (tPA) if the tPA is given within three hours of the attack of symptoms. (14) Strict adherence to the protocol for tPA administration increases efficacy and safety. (15) Hospitals that provide crisis stroke care should have a protocol in place for tPA administration or be prepared to transfer patients to a better equipped facility.

Not all hospitals have 24-hour radiology, laboratory, and neurosurgery services. Hence, the staff and administrators of each hospital must determine the horizontal of stroke care their institution can provide. The community then must determine the best use of local resources to accommodate its residents. (16)

As family physicians, we can do a great quantity [i]or[/i] amount of to increase awareness of pat promote its prevention, and provide education about its treatment. We can implement office a whole s to enhance prevention, and we can establish awareness campaigns in our offices, in exigency responders, in hospitals, and within our communities. through helping to create these regularitys family physicians can work with their communities to decrease the morbidity, mortality, and costliness of this devastating illness.

REFERENCES

(1) Minino AM, Arias E Kochanek KD Murphy SI, Smith BL Deaths: final data for 2000 Natl Vital Stat Rep 2002;50(15):1-119

(2) American Heart Association. Heart disease and thump statistics--2003 update. Dallas: American Heart Association, 2002 Accessed October 10 2003 at: http://www.americanheart.org/ downloadable/heart/10590179711482003HDS StatsBookREV7-03.pdf.

(3) Goldstein LB Gradison M Stroke-related knowledge among patients with access to medical care in the visitation belt. J Stroke Cerebrovasc Dis 1999;8: 349-52

(4) Pancioli AM, Broderick J Kothari R Brott T Tuchfarber A, Miller R et al. Public perception of thump warning signs and knowledge of potential risk factors. JAMA 1998;279:1288-92

(5) Ezekowitz JA, Straus SE Majumdar SR McAlister FA. Stroke: strategies for primary prevention. Am Fam Physician 2003;68:2379-862389-90