After a Stroke: The First 24 Hours

Quick summary

It's a frightening time when your parent 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

Your parent's 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 your parent seen right away. Ideally, your parent 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 your parent is in the ER: Determine what type of stroke your parent is 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 your parent is having, ER staff will:

• Monitor vital signs (blood pressure, heart rate, breathing, and body temperature)
• Draw blood to determine if your parent 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 your parent's veins so the staff can deliver fluids and medications

Doctors will treat your parent to minimize brain damage and the chance of more strokes. If your parent is 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, your parent will 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 your parent is having a hemorrhagic stroke, he'll be admitted to a special stroke unit or intensive care unit (ICU) as quickly as possible.

What you can do to help

If your parent was transported to the hospital by ambulance, the ER staff should already know the nature of his emergency. Still, your parent 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 parent. In his book Stroke for Dummies, John Marler says that something is wrong if your parent 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 your parent has 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 your parent's 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 your parent, in addition to the details about this particular event. Has your parent had a stroke before? If so, when and what kind was it? What medications is your parent 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 your parent? If not, why not? Can your parent's 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 your parent's 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 your parent 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 your parent's agent in an advanced health care directive.
  

But your role doesn't end once you're comfortable with how your parent 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.