While most physicians accept in theory the importance of acute stroke management, there remains a non-urgent approach to stroke at many hospitals. Prior to the approval of t-PA for acute stroke by the FDA in June of 1996, there were no approved agents established by clinical trials to improve neurologic outcome for patients with acute ischemic stroke. More traditional emergent management involves identifying hemorrhages, optimal control of blood pressure, oxygenation, identifying and treating metabolic derangements contributing to brain injury, and diagnosis of cardiac disorders that could be the consequence or cause of acute stroke. At time of first medical contact, the patient with stroke should be evaluated for an open airway, adequate breathing, and intact circulation. When the diagnosis of ischemic stroke has been established by CT, continued close monitoring of vital signs will quickly identify hypotension or extreme hypertension, and head elevation will reduce intracranial pressure.
Cerebellar infarction requires neurosurgical consultation.
Urgent laboratory evaluation will identify conditions which warrant immediate attention such as hyper- or hypoglycemia, other metabolic abnormalities and bleeding disorders. Close monitoring of vital signs and the urgent laboratory evaluation will also provide necessary information for a potential t-PA candidate. An arterial blood gas is indicated in comatose patients and those with hypoxia or respiratory compromise. Chapter 10, Advanced Cardiac Life Support. American Heart Association.