The 2021 primary diagnosis and treatment guidelines for ischemic stroke are released. These 5 details should be known!

*Only for medical professionals.
What is the difference between the reference practical version and the original version? What does "basic level" mean? In September 2021, "Chinese Journal of General Practitioners" published "Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021)" (hereinafter referred to as non-practical version) and "Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (Practical Edition 2021)" ( Hereinafter referred to as the practical version) (Figure 1), "Medical Neurology Channel" will take you into these two guides
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Figure 1 The two guidelines issued in September 2021[1,2] Which doctors are the guidelines suitable for? There is the word "basic level" in the title, and the scope of use of these two guidelines points to general practitioners in basic medical institutions[1]
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Checking the "Chinese Journal of General Practice", we can find that the magazine has published a series of guidelines for primary diagnosis and treatment
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In 2019, a seminar on the development of guidelines for the diagnosis and treatment of common diseases in primary medical and health institutions was held [2]
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Primary-level medical institutions play an important role in the three-level prevention of diseases.
The formulation of primary-level diagnosis and treatment guidelines will help improve the level of diagnosis and treatment of primary-level medical institutions, standardize the diagnosis and treatment process, and help implement the medical reform "guarantee basics, strengthen grassroots, and build mechanisms.
"
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At present, the basic diagnosis and treatment guidelines for the nervous system include diseases such as Parkinson's disease, dizziness/vertigo, and ischemic stroke
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I believe that guidelines for other diseases of the nervous system will be released one after another, and the "Medical Community Neurology Channel" will continue to pay attention
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In addition to general practitioners, other doctors can also read and study these two guides
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On the one hand, these two guidelines comprehensively and concisely summarize the evidence-based medicine evidence of ischemic stroke; on the other hand, through the guidelines, it is possible to understand the transfer of patients with ischemic stroke between different medical institutions from the perspective of the entire disease process.
Introduce the process to enhance the overall view
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In the process of diagnosis and treatment, we should think about where we are in stroke diagnosis and treatment, what processes the patient has gone through before, what processes he/she may have to go through afterwards, and how we should do a good job of connecting
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What is the difference between the two guides? In this series of guidelines for primary diagnosis and treatment, most of them will write two guidelines for the same disease, one of which is labeled "practical version
.
"
The two guides are generally consistent in content
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The non-practical version is written in detail, explaining the content of each part, and reading can enhance the understanding of clinical diagnosis and treatment methods
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The practical version is written concisely and clearly, and the structure is the same as the non-practical version, but the content is concise and directly lists the content that needs to be mastered
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It is recommended to use the practical version for daily quick reference
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In addition, the non-practical version lists a very practical appendix at the end, including the commonly used scales in the diagnosis and treatment of ischemic stroke: transient ischemic attack early stroke risk prediction-ABCD2 score scale ischemic stroke recurrence Risk-the severity of neurological dysfunction in stroke patients with Essen score-the National Institutes of Health Stroke Scale (NIHSS) score scale atrial fibrillation risk of cardiogenic embolism-CHA2DS2-VASc score bleeding risk in patients with atrial fibrillation- —HAS-BLED score primary care institutions should do these details ■ Detail 1: Etiological analysis of ischemic stroke Master the etiological analysis of ischemic stroke, comprehensively analyze the risk factors, etiology and pathogenesis of ischemic stroke[ 1]
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Risk factors, namely screening of patients with or without hypertension, diabetes, dyslipidemia, smoking, drinking and so on
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The specific cause of this disease, is aortic atherosclerosis, cardiogenic embolism, or other? The pathogenesis of the patient must also be clarified.
For example, if the cause is large atherosclerosis, is the pathogenesis of the patient atherosclerotic plaque shedding or arterial occlusion? Carrying out a complete etiological analysis is helpful for systematic thinking and building an etiological framework for each patient (Figure 2)
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Figure 2 Etiological analysis of ischemic stroke ■ Detail 2: Pre-hospital links Pre-hospital includes six links, namely: pre-hospital education, emergency response, on-site assessment, on-site treatment, transportation and connection [1]
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Primary-level doctors are often the first to contact patients with suspected stroke.
Effective and rapid pre-hospital treatment will shorten the time from onset to treatment, buy more time for emergency treatment, and improve treatment results
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The guide lists the most commonly used simple stroke identification methods at home and abroad, including BEFAST test, FAST test and "Stroke 1-2-0"
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The purpose of identifying stroke patients in a timely manner is to enter the scene as soon as possible for on-site evaluation and on-site treatment, and to simultaneously initiate the emergency response, transfer, and connection procedures
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On-site assessment can be summarized as recording personal information (name, gender, age), onset (time of onset, symptoms and evolution), personal history (smoking, drinking, etc.
), past history (illness, medication, other treatments)
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The guide gives 4 on-site treatments and some operations to avoid, as shown in Table 1
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Table 1 Pre-hospital treatment of ischemic stroke [1,2] ■ Detail 3: Keep in mind that the time window for revascularization or revascularization treatment is the brain.
There are various time windows for the treatment of ischemic stroke
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The guide summarizes these time windows, giving you a big game of treatment time windows, as follows [1,2]: Intravenous thrombolysis: rt‑PA treatment for 3.
0 to 4.
5 hours, urokinase for 6 hours; imaging 9 hours under the guidance of the penumbra assessment
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Arterial thrombolysis: 6 hours
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Mechanical thrombectomy: within 6 hours, it can be extended to 24 hours under the guidance of imaging penumbra evaluation
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The best transfer time: be transferred to a higher level hospital within 1 hour of onset
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The best treatment time: Recanalize blood vessels within 1.
5 hours
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■ Detail 4: Primary management of ischemic stroke.
Primary doctors will conduct primary management of ischemic stroke in terms of health education and health assessment, primary prevention of ischemic stroke, secondary prevention, rehabilitation treatment, and follow-up management
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Grassroots doctors participate in training on the prevention and management of ischemic stroke, establish health records of residents, and screen for risk factors
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Commonly used scales for risk factor screening, non-practical versions are listed in the appendix
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Develop primary and secondary prevention strategies for patients who have not suffered from ischemic stroke and those who have already suffered from ischemic stroke
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Basic-level doctors can fully communicate and discuss with community residents, and carry out education and education related to stroke prevention and treatment
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Regular follow-up of patients' risk factor control status, medication compliance, etc.
, formulate and improve community rehabilitation strategies
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See the content and flow chart of the primary management of ischemic stroke in the guidelines [1,2] (Figure 3)
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Figure 3 Primary-level management process of ischemic stroke [1,2] ■ Detail 5: The guideline for emphasizing epidemiological data specifically proposes that primary-level doctors should also master epidemiological methods
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The follow-up and management of patients with ischemic stroke include not only the diagnosis and treatment in the clinic, but also the data management of primary patients
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Primary-level doctors can grasp primary-level information on patients' primary treatment and rehabilitation, which are valuable data for studying the outcome and prognosis of patients in the real world
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The use of scientific methods to analyze it will help to evaluate the effect and improve the grassroots management strategy
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The diagnosis and treatment of ischemic stroke covers multiple modules such as prehospital, emergency, hospitalization, rehabilitation, and long-term management, covering the primary, secondary, and tertiary prevention of ischemic stroke.
The modules need to be handled properly and smoothly connected
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The two guidelines will help primary clinics to play an important role in the pre-hospital, rehabilitation, and long-term management modules
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References: [1] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, etc.
Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021) [J].
Chinese Journal of General Practitioners, 2021, 20 (9):927-946.
DOI: 10.
3760/cma.
j.
cn114798-20210804-00590.
Link: https://d.
wanfangdata.
com.
cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjEwOTA5EhF6aHFreXN6ejIchoJOTA,Chinese Medical Association[Chinese DWA]WF6aHFreXN6ejIwMhoj Association Magazine, Chinese Medical Association General Practice Branch, etc.
Guidelines for the Primary Diagnosis and Treatment of Ischemic Stroke (Practical Edition·2021)[J].
Chinese Journal of General Practitioners,2021,20(9):947-958.
DOI: 10.
3760/cma.
j.
cn114798-20210804-00591.
Link: https://d.
wanfangdata.
com.
cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjEwOTA5EhF6aHFreXN6ejIwMjEwOTA3wMxoIMWcJ1Zn.
"Some explanations for writing [J].
Chinese Journal of General Practitioners, 2021,20(9):923-926.
DOI:10.
3760/cma.
j.
cn114798-20210804-00592.
Link: https://d.
wanfangdata .
com.
cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjEwOTA5EhF6aHFreXN6ejIwMjEwOTAwMRoIbTJnNnY3Mmo%3D[4]Han Jing, Huang Meiqing, 2018 :10.
3969/j.
issn.
1000-8039.
2018.
13.
003.
Link: https://d.
wanfangdata.
com.
cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjEwOTA5EhF6aHl4eHhkYjIwMTgxMzAwMxoINGNoNXF0bGY%3D