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(Stroke. 2004;35:1018.)
© 2004 American Heart Association, Inc.

Controversies in Stroke

Stroke Unit Design: Intensive Monitoring Should Be a Routine Procedure

From the Department of Neurology, University of Heidelberg, Germany.

Correspondence to Thorsten Steiner, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany. E-mail thorsten_steiner@med.uni-heidelberg.de

Key Words: monitoring • ischemic stroke • intracerebral hemorrhage • stroke unit • neuro intensive care

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"That deaf dumb and blind kid sure plays a mean pinball."

"Pinball Wizard" from "Tommy, " The Who, 1969

Tommy, the protagonist of The Who’s first rock opera, became pinball champion although he was deaf and blind (a psychogenic disorder, as we all know). He plays the pinball machine by "intuition," doesn’t see the ball or hear the whistles and sounds, and doesn’t see the lights and the flippers; nevertheless, he always wins.

However, only few are so gifted that they can champion demanding tasks by intuition, by intent neglecting helpful information that is easily available. In acute stroke management on a stroke unit, general patient management can be handled in several ways: (1) by intuition, (2) on the basis of results of repeated physical examinations and daily assessment of physiological parameters twice or 3 times daily, or (3) with the assistance of continuous monitoring of physiological variables such as blood pressure (BP), heart rate, respiration rate, fever, or oxygen saturation, also known as physiological continuous monitoring. Using the pinball machine example, option 1 would be Tommy’s approach, option 2 would mean playing the machine occasionally, and option 3 would represent a concentrated attempt to score high points.

What do we mean by "monitoring?" There are at least 2 aspects: first, physiological monitoring may serve as a surrogate for frequent clinical examinations that cannot be performed as often as desired because of a shortage of personnel; and second, monitoring may detect changes in physiological variables that cannot be assessed directly . . . [Full Text of this Article]

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