Stroke, part 4 (Quick Guide)

Question 1

first steps in stroke

Answer 1

1. ABC
2. Establish IV access (for possible thrombolytic therapy; do NOT delay brain imaging for prolonged IV access attempts)
3. Pulse oxymetry to detect hypoxia; O2 supp only to maintain SpO2 >94%
4. CBG

Question 2

Next steps in stroke mgt

Answer 2

5 - CT/MRI
6 - ECG (ACS, A. fib)
7 - NPO order (to protect vs aspiration)
8 - strict bed rest in the ED (to protect vs falls and seizures)
- reasonable to raise bed to 15-30 degrees in px at risk for hypoxia, airway compromise, aspiration, or suspected increased ICP

Question 3

further work-up in stroke mgt

Answer 3

9. CBC with plt (polycythemia, thrombocytosis/-penia)
10. PT/PTT
11. electrolyte levels
12. Cardiac biomarker levels

Question 4

workup in selected stroke patients

Answer 4

a. CXR - where a cardiopulmonary C/I is suspected (e.g. hemothorax, suspected aortic dissection or pericarditis)
b. Urinalysis - infection mimicking stroke
c. Pregnancy test (if female of childbearing age) - influences dx and mgt considerations
d. Toxicology screen and/or blood alcohol levels - stroke mimics (e.g. cocaine, meth, phencyclidine)
e. lumbar puncture (if infection or subarachnoid hemorrhage suspected) - again to detect stroke mimics