Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window - Stroke EXTRA Supplement

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.