2013 Florida Stroke Symposium (FSS)

Thursday, May 9, 2013

4:00 P.M. Hotel arrivals

Friday, May 10, 2013

8:00 – 8:45               Registration and continental breakfast

8:45 – 9:00                Introductions

9:00 – 10:00             Prehospital management – best practices. This aim of this talk will be to discuss the best practices in managing the prehospital care of an acute stroke patient with the goal of minimizing the time between the onset of stroke and an acute hospital intervention. This talk will begin with the initial recognition that someone is having a stroke and then discuss best practices in the 911 call, triage of the stroke patient by the EMS dispatcher, EMS stroke recognition at the scene, transport, and communication with the acute hospital stroke team en-route. Issues surrounding EMS direct transport to a comprehensive stroke center rather than the nearest hospital or primary stroke center will be considered.  At the end of this talk, the participant should understand the issues related to prehospital stroke care as well as some possible solutions to minimizing the time between stroke onset and intervention. (Todd J. Crocco MD, Professor & Chair, Department of Emergency Medicine, West Virginia School of Medicine)

10:00– 11:00           Legal issues surrounding acute stroke care. The aim of this talk is to understand legal aspects of acute stroke care. Topics to be covered in this talk include the following: What are the liabilities of giving or not giving rTPA within the first 3 hours or between 3 and 4.5? Is there any excess liability in acute interventional approaches to stroke within the first 6 to 8 hours? What liability could be incurred by “bypassing” primary stroke centers and having EMS take stroke patients directly to a comprehensive stroke center?  What liability is involved in transferring or not transferring a patient to a comprehensive stroke center. What If a comprehensive center has an interventionalist but does not call him in for an acute stroke? By the end of this talk, the participant should understand his or her legal obligations in caring for stroke patients and understand how to minimize the risk of legal suits.(Joseph P. Wood MD JD, Assistant Professor Emergency Medicine, Mayo Clinic Medical School)

11:00 – 11:15          Coffee Break

11:15 – 12:15           Ischemic stroke – Update on acute management. This talk will discuss current best practice in acute ischemic stroke management. It will include how to manage fluid and blood pressure, update the current use of rTPA and other medications that should be used in acute ischemic stroke, and discuss acute surgery or stenting for symptomatic carotid  stenosis/ occlusion as well as hemicraniectomy for malignant MCA stroke. By the end of this talk, participants should understand the acute hospital management of acute ischemic stroke. (Michael J. Katsnelson MD, Assistant Professor of Clinical Neurology, Jackson Memorial Miller School of Medicine, University of Miami)

12:15 – 1:00            Lunch

1:00 – 2:00              Neurointervention – Techniques and outcomes. This talk will review results of the Interventional Management of Stroke III Trial (IMS III) and the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, other new or older device trials, describe new devices or procedures and how these results, devices, and /or procedure affect the acute interventional management of ischemic stroke. By the end of this talk, participants will understand the potential benefits and limitations of the interventional management of stroke. (Ridwan Lin MD, Interventional Neurologist, BrowardHealth North Comprehensive Stroke Center, Deerfield Beach, Florida)

2:00 – 3:00               Prevention of stroke update. This talk will describe primary and secondary stroke prevention. Topics to be covered include clopidogrel resistance and its significance, as well as other newer antiplatelet agents, lipid lowering agents and their role in stroke prevention,  and  current management of atrial fibrillation before and after stroke, and management of asymptomatic carotid stenosis. Participants should understand the use of antiplatelet agents, statins and other lipid lowering medications, Coumadin and other direct thrombin inhibitors for the prevention of stroke. (Steven R. Levine MD, Professor of Neurology & Emergency Medicine, The State University of New York (SUNY) Health Science Center – Brooklyn Downstate Stroke Center)

3:00 – 3:15              Coffee Break

3:15 – 4:15              Intracerebral hemorrhage –medical update. This talk will describe the pathophysiology of intracerebral hemorrhage, its clinical course and best management practices including current recommendation for blood pressure management, surgical indications and the medical correction of coagulopathies. If, when, and how to restart aspirin or anticoagulation after intracerebral hemorrhage will be covered. At the end of this talk, participants will understand current best medical and surgical practices for treating acute intracerebral hemorrhage. (Kiwon Lee MD, Associate Professor,  Department of Neurology, Co-Medical Director, Neuroscience Intensive Care Unit and Neurosurgery Intermediate Care Unit, The University of Texas Medical School at Houston)

4:15 – 5:15               Intracranial hemorrhage – neurosurgical update on subdural hematoma and intracerebral hemorrhage. Subdural hematoma is a common acute or subacute emergency which is generally managed by neurosurgeons and frequently poorly understood by neurologists and other medical professionals. This talk will discuss the etiology, presentation, management, complications and outcome of subdural hematoma as well as the surgical management of intracerebral hemorrhage  At the end of this talk, health professionals will have a better understanding of the evaluation and management of subdural hematoma and surgical management of intracerebral hemorrhage. (Roberto C. Heros MD, Professor and co-chair of Neurological surgery, University of Miami Miller School of Medicine)

5:15 –6:15               American Stroke Association – Highlights of the 2013 Meeting Update. Many Florida health professions may be unable to attend the American Heart Association International Stroke Meeting. This talk will highlight exciting new information about stroke presented at this year’s international meeting.  (Ridwan Lin MD, Interventional Neurologist, BrowardHealth North Comprehensive Stroke Center, Deerfield Beach, Florida)

Saturday, May 11, 2013 – Florida Stroke Systems of care – What is the future of Stroke care in Florida?

8:00 – 9:00                              Breakfast

8:15 – 8:30 Update on American Stroke Association “Get with the Guidelines”

8:30 – 9:00 Update on Florida – Puerto Rico Stroke Registry (Jose Romano MD, Chief, Stroke Division University of Miami Miller School of Medicine)

9:00 – 10:00             Florida stroke demographics / How is acute stroke currently managed in the state of Florida? This talk will discuss current primary and comprehensive networks of care in Florida as well as the use of telemedicine in Florida. It will also include a description of capabilities of current comprehensive stroke centers in Florida (Evan Allen MD, Medical Director of the Neuroscience Institute, Florida Hospital Orlando)

10:15 – 10:45          Update on Joint Commission (JCAHO) Comprehensive Care Centers (Fadi Nahab MD, Medical Director Stroke Program, Emory University Hospital) This talk will discuss Emory University’s experience in applying to become a Joint Commission certified Comprehensive Care Center.

10:45- 11:00            Coffee Break

11:00 – 11:30          Florida State government and Stroke. (Jeffrey N. Gregg, Chief, Bureau of Health Facility Regulation, Agency for Health Care Administration, Tallahassee, Florida) This talk will discuss the State’s current and future role(s) in stroke care in the Florida. A State representative will discuss ACHA certification for comprehensive stroke center, the state’s role in Emergency Medical Services and any future plans for the State government to participate in stroke care. By the end of this talk, the participant should have a good understanding of how the State government may help to improve stroke care in Florida.

11:30 – 12: 30           Organizing Primary and Comprehensive Florida Stroke Systems of care.  This panel discussion will begin with a brief introduction to systems of care followed by structured questions to our panel of experts who will discuss the potential future of stroke systems of care in Florida. These structured questions will be followed by open questions and comments from the audience. By the end of this panel discussion, participants should understand several potential avenues to organize and improve stroke care in Florida. Panelists will be:

Joe Nelson MD, Florida EMS Director

Jeffrey N. Gregg, Chief, Bureau of Health Facility Regulation, Agency for Health Care Administration, Tallahassee, Florida

Evan Allen MD, Medical Director of the Neuroscience Institute, Florida Hospital Orlando

Jose Romano MD, Chief, Stroke Division University of Miami Miller School of Medicine

 Michael J. Katsnelson MD, Assistant Professor of Clinical Neurology, Jackson Memorial Miller School of Medicine, University of Miami

Ridwan Lin MD, Interventional Neurologist, BrowardHealth North Comprehensive Stroke Center, Deerfield Beach, Florida

12:30                       Closing remarks – Plans for future meetings

 

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