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Care After Stroke

What to Expect for the First 24 Hours After a Stroke

By , Caring.com senior editor
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What happens at the hospital after someone has a stroke

It's a frightening time when someone close to you has a stroke. But you can help him get the best treatment possible -- and have the best chance of recovery -- by being his advocate in the emergency room. Here's what will happen in the ER and what you can do to assist.

First stop after a stroke: The emergency room

The first stop after a stroke will be the hospital emergency room. If you've ever been in an ER waiting room, you're probably familiar with the crowds and chaos that characterize them. Doctors and nurses are spread thin, and the intake nurse usually does triage (figures out who needs to be seen first).

However, a stroke is a major medical emergency, so be assertive about having the person you're caring for seen right away. Ideally, he was transported to the ER by paramedics, who normally tell hospital staff about the patient's condition -- but if not, you'll need to make sure staff know immediately.

Treatment and testing in the emergency room

The doctors have two main goals while a patient is in the ER: Determine what type of stroke he's having, and treat him to minimize brain damage and prevent more strokes.

Strokes are categorized as either ischemic or hemorrhagic. Ischemic strokes (also called white strokes) occur when a blood vessel to the brain is blocked, preventing blood from flowing to part of the brain. Hemorrhagic strokes (also called red strokes) are caused by a broken or torn blood vessel bleeding into or around the brain.

To determine what kind of stroke or medical event someone is having, ER staff will:

  • Monitor vital signs (blood pressure, heart rate, breathing, and body temperature)
  • Draw blood to determine if he has a clotting disorder that might preclude treatment with the clot-busting drug tPA
  • Check heart function (with an electrocardiogram, or EKG)
  • Perform a CT scan to detect bleeding in or around the brain
  • Run additional tests, such as an MRI, if the CT scan doesn't show what's causing the stroke
  • Possibly perform a spinal tap if bleeding still isn't detected but doctors suspect an aneurysm
  • Insert an intravenous (IV) line into one of his veins so the staff can deliver fluids and medications

Doctors will treat your friend or relative to minimize brain damage and the chance of more strokes. If he's having an ischemic stroke that began less than three hours ago, he will probably be given tPA (tissue plasminogen activator). However, tPA is not used for transient ischemic attacks (TIA), whose symptoms will clear up on their own. If tPA isn't used, he'll probably be given a different drug to minimize the risk of more clots forming. Ultimately, the cause of the original clot will need to be determined, but this can be done later.

If the person you're caring for is having a hemorrhagic stroke, he'll be admitted to a special stroke unit or intensive care unit (ICU) as quickly as possible.