Diagnosi e trattamento iniziale dell’ictus ischemico

• Patients presenting with signs and symptoms of TIA should be evaluated for risk of immediate future events using the ABCD score.
• Patients who present in time to be candidates for treatment with intravenous tissue plasminogen activator (tPA) should be evaluated by a physician within 10 minutes, undergo a CT scan within 25 minutes of arrival in the ED, and have CT interpreted within 20 minutes of test completion.
• tPA, if given, should be administered within three hours (4.5 hours in selected patients; see Annotation #18, “Consider IV Tissue Plasminogen Activator [tPA]/See Stroke Code Algorithm”) of stroke onset and less than 60 minutes of arrival at the ED.
• Patients presenting with stroke onset who are not candidates for intravenous tPA should promptly be given aspirin, after exclusion of hemorrhage on CT scan.
• Education regarding early stroke symptoms, risk factors, diagnostic procedures, and treatment options should be offered to the patient and family. This should be documented in the patient chart.
• Medical management for prevention of complications within the initial 24-48 hours of diagnosis and initial treatment of ischemic stroke include:
  - continue appropriate blood pressure management;
  - continue to treat hyperthermia;
  - continue to treat hypo- or hyperglycemia;
  - continue IV fluids;
  - initiate deep vein thrombosis prophylaxis;
  - perform swallow evaluation;
  - initiate early rehabilitation; and
  - perform nutritional status assessment.

• Stroke, Ischemic, Diagnosis and Initial Treatment of (Guideline)
• Stroke for Patient not Receiving tPA, Ischemic; Admission for (Order Set)
• Stroke for Patients Receiving tPA, Ischemic; Admission for (Order Set)