What are the first interventions in a hospital setting for stroke?

What are the first interventions in a hospital setting for stroke?

• A. Prevention of further increase of ICP: give oxygen, manage BP, keep the head of the bed up, diuretics, monitor ICP; determine stroke type by CT; treatment based on stroke type.
• B. Immediate anticoagulation without imaging.
• C. Start antiplatelet therapy before imaging.
• D. Hyperbaric oxygen therapy.

Answer: (A)

The first interventions in acute stroke focus on stabilizing the patient and preventing secondary brain injury while quickly determining the stroke type to guide specific therapy. This means ensuring adequate oxygenation, managing blood pressure to support brain perfusion without promoting edema or bleeding, and raising the head of the bed to about 30 degrees to help reduce intracranial pressure. Diuretics and close monitoring may be used if there are signs of increased ICP, and careful ICP monitoring is considered in patients with significant brain swelling. Crucially, a noncontrast CT scan of the head is obtained promptly to distinguish ischemic from hemorrhagic stroke, because treatment decisions hinge on that distinction. Once the stroke type is known, therapies are tailored accordingly (for example, reperfusion strategies for ischemic stroke or measures to control bleeding and reduce pressure for hemorrhagic stroke). Immediate anticoagulation or antiplatelet therapy before imaging is inappropriate because it can worsen hemorrhage, and hyperbaric oxygen therapy has no proven benefit in the acute setting.

The first interventions in acute stroke focus on stabilizing the patient and preventing secondary brain injury while quickly determining the stroke type to guide specific therapy. This means ensuring adequate oxygenation, managing blood pressure to support brain perfusion without promoting edema or bleeding, and raising the head of the bed to about 30 degrees to help reduce intracranial pressure. Diuretics and close monitoring may be used if there are signs of increased ICP, and careful ICP monitoring is considered in patients with significant brain swelling. Crucially, a noncontrast CT scan of the head is obtained promptly to distinguish ischemic from hemorrhagic stroke, because treatment decisions hinge on that distinction. Once the stroke type is known, therapies are tailored accordingly (for example, reperfusion strategies for ischemic stroke or measures to control bleeding and reduce pressure for hemorrhagic stroke). Immediate anticoagulation or antiplatelet therapy before imaging is inappropriate because it can worsen hemorrhage, and hyperbaric oxygen therapy has no proven benefit in the acute setting.