Patient Education Series | Treating Strokes in the ER | Edward Chew, MD
Dr. Edward Chew is an accomplished Emergency Physician based in New York, New York, where he serves as the Chief of Emergency Medicine at PAGNY for NYC Health + Hospitals/Harlem. His dedication to his team and their shared commitment to patient care drive his work every day. Dr. Chew's leadership extends to his role as... more
Stroke Treatment in the Emergency Room: A Comprehensive Guide
Stroke is a medical emergency that requires immediate attention and intervention. When someone experiences a stroke, quick and appropriate treatment can make a significant difference in their recovery and long-term outcomes. Here's what happens in the emergency room when someone has a stroke.
Understanding Stroke: A stroke occurs when blood flow to the brain is disrupted, either due to a blockage in a blood vessel (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). Without adequate blood flow, brain cells quickly begin to die, leading to potentially permanent brain damage.
Emergency Room Evaluation: When someone arrives at the emergency room with symptoms of a stroke, the medical team acts quickly to determine the type of stroke and the best course of treatment. This evaluation may include:
Physical Examination: The medical team performs a thorough physical examination, checking vital signs and assessing neurological function, such as strength, sensation, and coordination.
Imaging Tests: Imaging tests, such as a CT scan or MRI, are performed to visualize the brain and determine the cause and extent of the stroke. These tests can help differentiate between an ischemic stroke and a hemorrhagic stroke.
Blood Tests: Blood tests are done to assess factors such as blood sugar levels, clotting function, and cholesterol levels, which can affect stroke risk and treatment decisions.
Treatment of Ischemic Stroke: In the case of an ischemic stroke, where a blood clot is blocking blood flow to the brain, the primary goal of treatment is to restore blood flow as quickly as possible. Treatment options include:
Intravenous Thrombolytic Therapy: A medication called tissue plasminogen activator (tPA) is administered intravenously to dissolve the blood clot causing the stroke. This treatment is most effective when given within the first few hours after the onset of symptoms.
Endovascular Therapy: In some cases, a procedure called mechanical thrombectomy may be performed. During this procedure, a catheter is used to remove the blood clot directly from the blocked blood vessel.
Treatment of Hemorrhagic Stroke: For a hemorrhagic stroke, where there is bleeding in the brain, treatment focuses on controlling the bleeding and reducing pressure on the brain. Treatment options may include:
Medications: Medications may be given to lower blood pressure, prevent seizures, and reduce swelling in the brain.
Surgery: In some cases, surgery may be necessary to remove the blood clot, repair damaged blood vessels, or relieve pressure on the brain.
Rehabilitation and Recovery: After the acute phase of treatment in the emergency room, stroke survivors often require ongoing rehabilitation to regain lost function and improve their quality of life. Rehabilitation may include:
Physical Therapy: To improve strength, balance, and mobility.
Occupational Therapy: To help with activities of daily living, such as dressing, bathing, and eating.
Speech Therapy: To address difficulties with speech, language, and swallowing.
Psychological Support: Stroke survivors may also benefit from counseling or support groups to help cope with the emotional and psychological effects of stroke.
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