Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window - Stroke EXTRA Supplement (Stroke CME) | Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window - Stroke EXTRA Supplement (Stroke CME)
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Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window - Stroke EXTRA Supplement (Stroke CME and Pharmacology CME)

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Points & Pearls Excerpt

  • A key element of the history is to obtain the patient’s last known well time, which must be differentiated from the first time that symptoms were noted by witnesses. Often, collateral history will need to be obtained from family or friends.
  • Severe hypoglycemia or hyperglycemia can mimic the symptoms of an acute stroke. Point-of-care glucose is a rapid test that is widely available in the ED. Glucose levels should be assessed in every patient presenting with an acute stroke, and corrected, if necessary.
  • In patients with a history of a hematologic disorder on anticoagulation, or with a suspicion for a coagulopathy, basic coagulopathy tests including platelet count, INR, and aPTT should be obtained prior to administration of IV tPA.
  • Prior to treatment with either IV tPA or mechanical thrombectomy, blood pressure should be <185/110 mm Hg and should be maintained at <180/105 mm Hg for 24 hours after treatment. In patients who are not treated with IV tPA or mechanical thrombectomy, blood pressure should be maintained at <220/120 mm Hg.
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Publication Information
Authors

James Pham Ho, MD

Peer Reviewed By

Rhonda Cadena, MD; Holly K. Ledyard, MD, MS

Publication Date

June 15, 2021

CME Expiration Date

June 15, 2024

CME Credits

4 AMA PRA Category 1 Credits.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke CME and 1 Pharmacology CME credits, subject to your state and institutional approval.

Pub Med ID: 34133111

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CME Information

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