Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Immediate management steps for a patient presenting with an acute ischaemic stroke:
- Emergency admission: Arrange immediate emergency admission to an acute stroke facility or hyperacute stroke unit for anyone with suspected acute ischaemic stroke. Ensure the hospital receives advanced notification of arrival including time of onset, symptom evolution, current condition, and medications, especially anticoagulants.
- Initial assessment and monitoring: While awaiting transfer, monitor and manage airway, breathing, and circulation (ABCs). Provide supplemental oxygen only if oxygen saturation is below 95% and there are no contraindications.
- Exclude hypoglycaemia: Check and exclude hypoglycaemia as a cause of neurological symptoms.
- Urgent brain imaging: Perform brain imaging urgently, ideally within 1 hour of hospital arrival, using non-enhanced CT to exclude intracranial haemorrhage before starting any anticoagulation or antiplatelet treatment.
- Thrombolysis: Consider intravenous alteplase treatment if started as soon as possible within 4.5 hours of symptom onset and after excluding intracranial haemorrhage by imaging. This should be administered only within a well-organised stroke service with trained staff and immediate access to imaging.
- Thrombectomy: Offer mechanical thrombectomy as soon as possible and within 6 hours of symptom onset for patients with confirmed proximal anterior circulation occlusion, alongside intravenous thrombolysis if not contraindicated.
- Specialist care: Admit the patient directly to a specialist acute stroke unit for multidisciplinary assessment and management without delay.