Acute Ischemic Stroke: Management and Evaluation

00:00 So let's walk through the management and evaluation of a patient who is presenting urgently or acutely with an ischemic stroke. And one of the most important things to remember is time is brain. We must act as quickly as possible for these patients who are presenting with an ischemic stroke. The goal is to intervene as soon as possible and ideally within 60 minutes of their presentation. Time is brain. The longer that brain tissue is ischemic or infarcted, the more tissue will be lost. So let's walk through the initial evaluation of a patient suffering an acute ischemic stroke. Again, the diagnosis is made clinically and then we're looking for other diagnostic studies to be performed in the emergency department setting. The first is a non-contrast head CT to evaluate for hemorrhage and rule out a hemorrhagic stroke.

00:56 Patients suffering a hemorrhagic stroke go down an entirely different clinical care pathway from those with ischemic stroke. We check a fingerstick blood glucose check to evaluate for hypo or hyperglycemia, serum electrolytes, an EKG, cardiac enzymes, complete blood count to look at platelets and other blood counts, an INR is checked in many patients though not all patients. And sometimes, an activated partial thromboplastin time or APTT. Oxygen saturation is important and many patients will receive supplemental oxygen when suffering a stroke. Importantly, unless there are suspicion for abnormalities in the coagulation studies, we don't delay intervention for waiting for things like an INR, a PTT, or even a CBC. Time is brain. We want to rule out hemorrhagic stroke, evaluate for glucose abnormalities or electrolyte dysfunction, and then intervene as soon as possible.