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Good communication and teamwork before, during, and after are keys to minimizing the risk of stroke in patients undergoing cardiac and thoracic aortic surgery, according to a new scientific statement from the American Heart Association AHA. We have a duty to try to do everything we can to reduce the risk of stroke for our patients and that means basically working as a team. Gaudino added that the statement is part of an effort by the AHA to streamline the available data and create a resource that is more useful to the everyday physician than lengthier documents of the past.
Published online today in Circulation , the scientific statement reviews the incidence, diagnosis, and treatment of perioperative stroke. Based on recent data, including several reports from the TRICS group, Gaudino and colleagues also suggest adhering to a recommended transfusion trigger of 7. It is really true for stroke, because there is a limited window where we can be very, very effective in treating [it]. Postprocedure clinical evaluations should be considered an important early opportunity to observe stroke symptoms.
This type of evaluation, they add, should be performed routinely despite the lingering effects of anesthesia and other psychoactive medications. Stroke is definitely an outcome that we need to improve as a cardiovascular community. Mario Gaudino. This is where the multidisciplinary team becomes especially important, Gaudino said, and should consist of stroke neurologists, neurointerventionalists, neurocritical care specialists, and neuroanesthesiologists working alongside the surgical team.
Another important issue in all this is standardization of established protocols within a given hospital system, in order to ensure quick involvement of the acute stroke team and the earliest-possible interventions to minimize neurological injury and improve outcomes. Patients with suspected stroke should undergo a noncontrast CT of the head to rule out intracerebral hemorrhage and characterize signs of early ischemia. In addition, CT angiography should be included in the early imaging if large-vessel occlusion is suspected, and CT perfusion also can be performed to evaluate the cerebral vasculature.
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The Mazda CX-5 is a compact crossover produced by Mazda starting in for the model year lineup. It shares its platform with the Mazda3 and Mazda6 ,  and is also the first vehicle featuring the company’s full suite of SkyActiv technologies, using a rigid, lightweight platform combined with a series of engines and transmissions to reduce emissions and fuel consumption. Skyactiv engines and transmissions were first sold in the Mazda3.
Production models went on sale in , with a choice of a SkyActiv-D 2. Design changes were subsequently made that brought up the Small Overlap Front rating up to a Good rating. The small overlap test, introduced in by the IIHS, simulates a frontal collision on 25 percent of the driver’s side front corner. Since its adoption, the IIHS has noticed several automakers making non-symmetrical modifications to their vehicles to improve ratings.
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