- Assess ABCs
- IV access
- Oxygen supplement if hypoxic (<92%)
- Cardiac monitoring
- Bedside glucose assessment
- Hemoglobin determination (polycythemia can cause stroke)
- ECG and cardiac biomarkers
- Noncontrast head CT
- CBC including platelets
- Coagulation studies
- Electrolytes and renal function
- NPO- nothing by mouth
- Strict bed rest with the head of the bed elevated to 30 degrees (unless hypotensive)
- Protect against fall, seizure, or aspiration
- Consider urinalysis, pregnancy test, and toxicology
- Treat fever if present (fever increases mortality in stroke)
- Closely monitor blood pressure and if a candidate for rtPA, keep systolic at or below 185, and diastolic at or below 110 mm Hg.
- Hypertensive drug therapy choices: labetalol, nitroglycerin, nitroprusside, nicardipine
- If patient is not a candidate for rt-PA, permissive hypertension is allowed as long as BP is <220/120 mm Hg
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