Care After Stroke
What to Expect for the First 24 Hours After a Stroke
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.
What to Do in the Days After a Stroke
If the patient was transported to the hospital by ambulance, the ER staff should already know the nature of his emergency. Still, he needs you to serve as his advocate, which you can do in a number of ways:
- Speak up! Don't be shy or embarrassed to advocate for your good friend or relative. In his book Stroke for Dummies, John Marler says that something is wrong if someone who's had a stroke has been in the ER for more than five minutes without attention. You're not being pushy if you insist on his being seen immediately; stroke treatment is a race against time. Your job is to make sure the doctors and nurses understand that he's had a stroke.
- Report events accurately. Tell the ER staff exactly what happened and when it happened. For many strokes, treatment with intravenous clot-busting drugs can greatly reduce brain damage and increase the chances of recovery. But these drugs need to be administered within three hours of the onset of stroke symptoms -- and the sooner treatment starts, the better the outcome. So if his stroke began less than three hours before his arrival at the ER, it's even more critical that he be evaluated right away.
- Provide medical background. The ER staff will need to know important medical information about him, in addition to the details about this particular event. Has he had a stroke before? If so, when and what kind was it? What medications is he taking -- and does he actually take them as prescribed?
- Ask questions. Does the hospital have a stroke team? If so, is that who's treating the person you're caring for? If not, why not? Can his stroke be treated with drugs that dissolve blood clots? If so, has the treatment been started yet? If not, why not?
- Consider yourself part of the treatment team. Although you are his advocate, try not to be adversarial about it. James Frank, ICU director at the San Francisco Medical Center, spends much of his time talking to families of critically ill patients. "The best way you can advocate for someone is by working with the doctors and nurses," says Frank. He also recommends appointing a single spokesperson for the entire family so the ER staff isn't bombarded with questions and demands from different people. It's best if this spokesperson has durable power of attorney or has been appointed as the stroke survivor's agent in an advanced health care directive.
But your role doesn't end once you're comfortable with how your loved one is being cared for in the ER. Next he'll be moved into a hospital bed, where you can continue to be his staunch supporter and learn how to deal with the aftereffects of the stroke.