Winel Fonbah on the Critical Steps in Stroke Care: From Emergency Assessment to Secondary Prevention
Winel Fonbah, Registered Nurse at Regional hospital limbe, shared a post on LinkedIn:
“Stroke management depends on whether it’s an ischemic stroke (blocked blood vessel) or a hemorrhagic stroke (bleeding in the brain).
Immediate treatment is critical to minimize brain damage
1. Initial Assessment (Emergency Care)
• Airway, Breathing, Circulation (ABC)
• Check vital signs: BP, oxygen, heart rate, glucose
• Neurological assessment: Glasgow Coma Scale (GCS), NIH Stroke Scale
• History: Onset time, symptoms, risk factors (hypertension, diabetes, atrial fibrillation)
• Immediate imaging: CT or MRI to distinguish ischemic vs hemorrhagic stroke
2. Ischemic Stroke Management
Goal: Restore blood flow to the brain and prevent further clotting.
Acute Management (first hours)
• Thrombolysis: IV Alteplase (tPA) within 3–4.5 hours of symptom onset
• Mechanical thrombectomy: For large vessel occlusions, ideally within 6–24 hours
• Antiplatelet therapy: Aspirin if thrombolysis not given
• Anticoagulation: For cardioembolic stroke (e.g., atrial fibrillation), usually after acute phase
Supportive Care
• Oxygen if needed
• Manage blood pressure carefully
• Treat fever and hypoglycemia
3. Hemorrhagic Stroke Management
Goal: Control bleeding, reduce pressure, and prevent complications.
• Blood pressure management: Avoid further bleeding
• Surgical intervention: Craniotomy or hematoma evacuation if large or causing mass effect
• ICP (intracranial pressure) control: Mannitol, hypertonic saline
• Seizure prevention if needed
4. General Stroke Supportive Care
• Prevent complications: Deep vein thrombosis, aspiration, pressure sores
• Early mobilization and physiotherapy
• Swallowing assessment to reduce aspiration risk
• Nutrition support
5. Secondary Prevention
• Lifestyle modifications: Stop smoking, maintain healthy weight, exercise
• Control risk factors: Hypertension, diabetes, dyslipidemia
• Medications:
• Antiplatelets (aspirin, clopidogrel)
• Anticoagulants if indicated
• Statins to reduce cholesterol
6. Rehabilitation
• Physical therapy for motor recovery
• Occupational therapy for daily activities
• Speech therapy for dysarthria or dysphagia
• Psychological support for cognitive or emotional changes.”
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