Follow the steps that need to be taken in acute-stroke management

Imagine this scenario: A 65-year-old male is playing golf with his buddies. While playing he suddenly begins to slur his words and his golfing buddies find it hard to understand him. He becomes disoriented. He starts to drag his right foot around, loses balance, and falls. Immediately he is taken to the hospital. He arrives at the emergency room 40 minutes from the onset of symptoms.

At the ER

• The patient is immediately seen by the ER doctor.

• The ER nurse calls the stroke unit/neuro-ICU. The senior nurse receives the call.

• Call received. The neurologist or stroke fellow and senior nurse rush to the ER.

• Patient is assessed, using the NIH Stroke Scale (for stroke deficits) and Glasgow Coma Scale (for patient sensorium)

• History taking. Checklist is used on the patient; both patient and relatives are asked.

• Physical exam and other tests done. Before treating the stroke, the type of stroke and its location are established.

• CT scanning. The stroke neurologist orders a CT scan.

• Patient stabilized. The patient's ABC is stabilized.

Criteria passed

• tPA given. The neurologist administers tPA, a clot-buster, intravenously.

• Clot is dissolved.

• Patient is assessed. Patient observed to be getting better, is then taken to the acute-stroke unit.

At the ASU

• Patient monitored. Patient is hooked to vital monitors for continuous monitoring.

• Drugs given. Specific drugs like calcium-channel blockers and neuroprotectants are given. Antiplatelets and anticoagulants may also be given.

• Vital signs monitored. Monitoring is done every 10 minutes or depending on how stable the patient is. Increased temperature may indicate increased intracranial pressure, abnormal pulse rate and rhythm suggest cardiac dysfunction, respiratory rate reflects carbon-dioxide level.

• Blood pressure managed. Antihypertensive drugs are given through an IV and infusion pump to control BP. BP checked almost every five minutes, watchful of sudden BP drops.

• Neurological status/neuro vital signs monitored. Neurologic exam assesses mental status, cranial nerves, motor, cerebellar, sensory functions, and deep tendon reflexes

• Identify patient needs.

• Worsening condition watched. The next 72 hours are very critical. A. Cababa