The central aspect of acute ischemic stroke emergency care – resuscitation of ischemic semidarkness. With the world’s three major mortality diseases including cardiovascular disease, cancer and stroke, we must acknowledge the relatively slow progress in research on effective clinical treatment of stroke. The main constraints are the suddenness and severity of the stroke disease itself and its rapid progression. Stroke can be prevented. Therefore, the first priority is public education and vigorous promotion of the concept that prevention is more important than treatment. The next step is to change poor lifestyles, especially in high-risk groups, and to start reasonable and effective drug therapy early. Public education on stroke knowledge should be vigorously promoted so that patients can detect their symptoms early at the onset of stroke and seek early medical attention for the thrombolytic treatment time window. The real long-term and fundamental approach is to let the public to prevent the disease voluntarily and consciously. Recombinant tissue-type fibrinogen activator (rt-PA) is the only drug approved by the FDA for use in the acute phase of stroke, but the strict time window for treatment and the risk of hemorrhagic transformation limit the widespread use of rt-PA. Ischemic stroke treatment time window —- Race against time, treatment against time Intravenous thrombolysis: within 4.5 hours? Arterial thrombolysis: within 6 hours. Be sure to master strict indications and timing of drug administration, preferably within 4.5 hours. The sooner the treatment is administered one minute earlier at this time, the sooner you leave paralysis and death! Objective of thrombolytic therapy To dissolve the thrombus and rapidly restore microcirculation in the infarcted area, thus obtaining early reperfusion of cerebral blood flow, reducing the degree of ischemia and limiting the damage to neural cells and functions. However, thrombolytic therapy is risky and is more likely to produce reperfusion injury, post-infarction hemorrhage and severe cerebral edema in certain areas of prolonged ischemia, the central ischemic zone and vulnerable areas. Stroke: a growing epidemic Aging, unhealthy diet, smoking, and low physical activity are accelerating the growing epidemic of hypertension, high cholesterol, obesity, diabetes, stroke, heart disease, and vascular cognitive disorders. Worldwide, stroke claims the lives of 5.7 million people each year, and four out of five stroke patients occur in low- and middle-income countries that struggle to withstand the dangers of stroke. It is now the number one cause of death in the country, surpassing the death rate from ischemic heart disease. It is also the leading cause of severe disability. The neurological emergency and thrombolysis team has opened up a green channel for emergency thrombolysis Immediate diagnosis and assessment: is it a stroke? Ischemic stroke? Ischemia, does it require urgent thrombolysis? Vascular distribution area? Possible etiology and pathophysiology? Severity? Life-threatening? Preliminary prognosis. These are especially important for the emergency physician to be able to judge quickly. Our hospital has a neurology emergency department and a stroke unit, so that a one-stop green channel from the thrombolysis emergency department to the stroke unit is opened, which greatly shortens the resuscitation time of the patient and greatly improves the quality of survival The neurological emergency physician conducts emergency neurological assessment (6 key factors) 1. Determine whether it is cerebrovascular disease Early identification of stroke 5 common Key warning signs: (1) Weakness, numbness or paralysis on one or both sides of the body, upper extremities, lower extremities or face (2) Sudden blurring of vision in one or both eyes, or loss of vision, or double vision. (3) Difficulty in verbal expression or comprehension. (4) Dizziness, loss of balance, or any accidental fall, or unsteady gait. (5) Headache (usually severe and sudden) or unexpected change in the pattern of headache 2. (3) The time of onset should be based on the last time the patient was found to be asymptomatic. 3. The patient’s level of consciousness should be determined according to the Glasgow Coma Scale (GCS). 4. Assessment of the type of cerebrovascular disease (hemorrhage or ischemia) Detailed history and careful neurological examination are very important, but the diagnosis should not be made solely on the basis of clinical manifestations. In most cases, non-enhanced CT scan is the decisive test to distinguish ischemic and hemorrhagic cerebrovascular disease. 5. Localization of cerebrovascular disease (carotid or vertebrobasilar artery) 6. For ischemic cerebrovascular disease determine the artery involved in the patient: carotid or vertebrobasilar system. Higher cortical, speech, visual, cranial nerve, motor, and sensory functions should be assessed in suspected cerebral infarction. Neurological signs can help distinguish infarcts in the carotid artery or vertebrobasilar system. 7. Assessment of cerebrovascular disease severity NIHSS scale (National Institutes of Health Stroke Scale) is reliable, accurate, and easy to use for neurological function assessment in patients with ischemic stroke. the total NIHSS score ranges from 0 (normal) to 42, assessing six major aspects of neurological function: level of consciousness, speech function, cranial nerve function? motor function, sensory and neglect, and cerebellar function. Management of blood pressure during thrombolysis An increase in blood pressure after the onset of ischaemic stroke does not usually require urgent treatment. One hour after the initial stroke, blood pressure decreases spontaneously in most patients with control of pain, agitation, vomiting and high cranial pressure, unless other medical disorders (myocardial infarction, heart failure, aortic coarctation) are present. For those requiring thrombolysis, blood pressure should be strictly controlled to <180 mmHg systolic or <100 mmHg diastolic, otherwise the chances of conversion to cerebral hemorrhage are greatly increased, which can be detrimental to the patient's prognosis or even lead to serious complications. Experienced thrombolysis team and strict thrombolysis process The thrombolysis team is formed by the close cooperation of multiple departments, including emergency medicine, neurology, interventional medicine and neurosurgery. Asking medical history should be carefully and quickly grasp the characteristics of medical history, do not ignore whether there is a transient onset before the onset and then recovery, which often suggests that transient ischemic attack, a danger sign of cerebral infarction, may be reoccurring, and should be seen in neurology as soon as possible to exclude the risk factors of stroke and prevent the real formation of stroke.