Acute stroke management

Admit patients with acute ischaemic stroke to Stroke Unit at City Hospital in order to:

• establish diagnosis accurately
• *prevent damage to ischaemic penumbra*
• arrange secondary prevention
• start early rehabilitation

The incidence of progression is high, at least 15-20%, and it usually happens in the first 48-72 hours. Patients on general medical wards do worse than at home, they need to be on a stroke unit!

Thrombolysis is effective up to 4.5 hours after onset, with no age limit, so admit patients with blue light if symptoms less than 4 hours.

Bat phone on Berman 1 ward (Stroke Unit)

Telephone: 0115 993 6602

One of the sisters on call will triage and arrange admission to Berman 1.

But send patients to ED if they have drowsiness or severe headache and vomiting at time of onset (suggests a bleed).

Ring Berman 1 for advice even if it is longer than 4 hours since onset.

Also discuss admitting patients with TIA if:

• New persistent focal neurology
• Multiple TIA
• TIA/Stroke already on warfarin
• Recent trauma

Source: personal communication Dr Subramanian February 2012