Two things COMPLETELY WRONG in this! 'Guidelines' and 'care'. If you can't see that you don't belong on stroke! Should be protocols and recovery! And this is from the incompetent AHA/ASA!
Guidelines in Action: Care Coordination Poststroke
A 78-year-old man with atrial fibrillation, diabetes, and hypertension presented to the emergency department with sudden onset of right-sided weakness and inability to speak. Acute ischemic stroke was suspected, and computed tomography angiography demonstrated occlusion of the left middle cerebral artery, which was treated emergently with thrombolysis and mechanical thrombectomy. The initial National Institutes of Health Stroke Scale score was 24 and improved to 12 after the acute stroke treatment.(So, COMPLETE FUCKING FAILURE AT 100% RECOVERY?) He was hospitalized on the acute stroke unit for 7 days, during which time a stroke workup was completed. Vascular risk factors were identified and treated by the stroke team, and physical, occupational, and speech therapies were initiated to reduce impairment. Case management was working with the patient and his family. The patient had intermittent atrial fibrillation with a rapid ventricular rate despite initial management, and cardiology consultation was completed. He was evaluated by the physical medicine and rehabilitation provider for comprehensive rehabilitation planning and coordination. Persistent neurological deficits included mild right-sided weakness, dysphagia, expressive and receptive aphasia, and cognitive impairment.
The patient transferred to an acute inpatient rehabilitation unit after medical stability was achieved and risk factors identified, where he received treatment for 11 days. During inpatient rehabilitation facility admission, caregiver training was implemented as he required supervision for safe mobility and assistance with communication. At the time of discharge, he was seen by the case manager, and home medical equipment as recommended by the rehabilitation therapists was authorized, including a walker. He was referred for home physical, occupational, and speech therapy, which continued for 2 weeks, after which he was then referred for continuation of stroke rehabilitation in the outpatient setting.
He was seen in the outpatient stroke clinic for follow-up 2 weeks after discharge from the inpatient rehabilitation facility. The patient was tolerating secondary stroke preventive medications, his blood pressure and heart rate were in the goal range, and the modified Rankin Scale score was 3. He continued to participate in outpatient stroke rehabilitation and was referred to a dietician for ongoing education. The patient also completed follow-up with a physical medicine and rehabilitation provider 1 month after discharge, was able to ambulate >200 feet without an assistive device under supervision, and was independent with feeding with resolved dysphagia.(So, COMPLETE FUCKING FAILURE AT 100% RECOVERY?)
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