title: Ischaemic stroke management by emergency care physicians at public sector hospitals of Karachi, Pakistan.
abstract: OBJECTIVE
  To assess the clinicians management of patients presenting with acute ischaemic stroke in the emergency departments of two large state run hospitals in Karachi, Pakistan.
  
  
  METHODS
  A questionnaire was filled by 59 registered medical practitioners working at these two government hospitals who would be managing stroke patients presenting in the emergency. It was a descriptive cross sectional study designed to assess the methods used by the doctors for diagnosing and treating stroke patients. The data was collected from October to November 2007 and entered using Epi Data Entry and analyzed by SPSS 13.0.
  
  
  RESULTS
  The preferred overall investigation for a suspected stroke patient in an emergency ward was an ECG (98%). 51% of the respondents would prescribe aspirin to most patients (300 mg by 40% respondents). Intravenous tissue plasminogen activator was thought to be beneficial by 43% of doctors, low molecular weight heparin by 91%, subcutaneous heparin by 86.5%, intravenous Vitamin B complex by 20% and steroids by 39% of respondents. Regarding elevated blood pressure, 60% answered that they would manage the blood pressure according to the type of stroke and 73% responded that they would lower blood pressure when it reached greater than 150/80. 88% of the doctors answered that they would use cholesterol lowering drugs in the management of stroke patients in an emergency. 97% of the doctors recommended rehabilitation and 88% of the respondents believed that there should be separate stroke units.
  
  
  CONCLUSIONS
  The development of a standardized protocol and stroke team is recommended which should speed the clinical assessment, decisions for early management and also increase the performance of diagnostic studies.
authors.affiliation: Dow Medical College, Civil Hospital, Karachi.
authors.forename: Faraz Khan
authors.initials: FK
authors.lastname: Luni
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Hamid
authors.forename: Salman
authors.initials: S
authors.lastname: Mamji
authors.forename: Shahid Masud
authors.initials: SM
authors.lastname: Baig
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents; D006493:Heparin / Q000627:therapeutic use; D006779:Hospitals, Public; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D010154:Pakistan; D010820:Physicians; D010975:Platelet Aggregation Inhibitors; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin