What are the initial steps in managing a stroke?

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Until recently, the treatment of Stroke was restricted to basic life support at the time of the stroke and rehabilitation later. Now, however, treatments are being used that are proving to be very beneficial when administered as soon as possible after the onset of the stroke. It is critical then to get to the hospital and be diagnosed as soon as possible.

• If significant symptoms appear in people at risk for stroke, calling 911 is critical (as opposed to calling the family doctor or trying to get the patient to the hospital by car). One study reported that patients who went to the emergency room in an ambulance had a much shorter delay in getting treatment than those who went on their own. Receiving treatment early is critical in reducing the damage from a stroke.
  
• Although administering aspirin within 48 hours may reduce the risk of a recurrent stroke, it should not be taken before the patient has entered the hospital. Aspirin increases the risk for bleeding in patients with Hemorrhagic stroke and would preclude important clot-busting drugs in patients with ischemic stroke.
  
• As soon as the patient enters the hospital, diagnostic tests, particularly a CT scan, should be obtained to help determine whether the stroke is ischemic or Hemorrhagic.
  
• The patient should receive treatment to support basic life functions and to reduce stress, pain, and agitation. Monitoring blood pressure and maintaining a healthy electrolyte balance (the ratio of sodium, calcium, and potassium in the body’s fluids) are critical.
  
• If the patient is diagnosed with Hemorrhagic stroke, blood pressures above 200 (systolic) or 100 (diastolic) should be treated. (Lowering blood pressure too quickly can be dangerous and it should be monitored carefully.)
  
• Hospital staff should watch carefully for increased pressure on the brain, which is a frequent complication of Hemorrhagic strokes. It can also occur a few days after ischemic strokes. A number of medications may be given during a stroke to reduce this risk. Early symptoms of increased brain pressure are drowsiness, confusion, lethargy, weakness, and headache.

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