Going to the Emergency Room for a Suspected Stroke

A stroke is an extremely dangerous medical emergency that requires immediate medical attention through calling 911 or visiting your nearest emergency room.

When you have a stroke, blood is no longer flowing to your brain like it normally would. This prevents your brain from getting enough oxygen, causing brain cells to start dying.

With a stroke, every second counts, so knowing the common symptoms of a stroke and why you should receive emergency room stroke treatment is very important. Knowing how to quickly identify signs of a stroke can save your life or the life of a person around you.

How to Recognize Stroke Symptoms

Just like any organ in your body, your brain requires oxygen and nutrients to stay alive and function normally. If something happens to the blood vessels supplying blood to your brain — such as forming a blood clot or bursting — this can automatically stop the flow of blood, causing brain cells to immediately start dying.

Past studies show that during a stroke, brain cells perish at a rate of about 1.9 million per minute, which is why it's vital to act fast if you suspect you or a loved one is having a stroke.

There are three types of strokes, and they include:

• Ischemic strokes, such as thrombotic strokes and embolic strokes, are caused by blood clots that form and block blood vessels.
• Hemorrhagic strokes, like an intracerebral hemorrhage or subarachnoid hemorrhage, happens when a blood vessel ruptures from high blood pressure, an aneurysm, or other means.
• Transient Ischemic Attack (TIA), also known as a mini-stroke, occurs by a temporary blockage in the blood vessels that normally fixes itself. However, having a TIA should be considered a warning that you may have a full stroke in the future.

Both ischemic and hemorrhagic strokes share some common symptoms. Ischemic stroke symptoms tend to gradually build over time, while hemorrhagic stroke symptoms can happen very quickly.

Common symptoms that mean you need stroke treatment include:

• Balance and coordination issues
• Confusion
• Dizziness
• Facial drooping
• Loss of consciousness
• Numbness or weakness in the arms and legs, especially if only on one side of the body
• Seizure
• Severe headache
• Stiffness or pain in the neck
• Sudden sensitivity to light
• Trouble speaking or understanding speech
• Vision changes

BE-FAST Method

In 1998, a group of physicians and emergency department personnel in the United Kingdom developed an easy-to-remember acronym and method to easily recognize stroke symptoms.

Originally known as FAST, it’s recently been updated to BE-FAST to include more symptoms:

B: Balance — loss of coordination or balance

E: Eyes — vision changes

F: Face — drooping on one side of the face

A: Arms — weakness in the arms or legs

S: Speech — cannot speak or understand speech

T: Time — call 911 immediately for stroke emergency room treatment

Try to note of when your symptoms first began, which can help doctors determine the best course of stroke treatment.

What to Do When You Suspect a Stroke

If you suspect you or a loved one is having a stroke, it’s important to act fast, yet as calmly as possible. Every second matters when it comes to a stroke; the quicker you act, the better your chances for a better outcome.

If you believe you need to visit the emergency room for stroke treatment:

• Immediately call 911 as calmly as possible, explain to them your symptoms and situation.
• Make a note of the time when your symptoms first started showing.
• Lie down or help the person having the stroke lie down, and keep the head slightly elevated to help maintain an airway.
• Find a way to support any limbs that may have become weakened.
• Loosen any restrictive or tight clothing — such as a tie or belt — to help blood flow.
• Stay with the person having a stroke, or have someone stay with you until paramedics arrive.
• Be ready to perform CPR if the person having a stroke stops breathing.

When the paramedics arrive, be clear with the emergency response team about your or the person's symptoms. They will ask you when the symptoms first started showing, if you or your loved one has any allergies, or are on any medications.

From there, the paramedic team will use the BE-FAST assessment, check the patient’s vital signs and may administer medications. They will then get the patient into the ambulance and to the nearest hospital or stroke center as quickly as possible.

What Not to Do When You Suspect a Stroke

Just as important as knowing what to do when you or a loved one has a stroke is knowing what not to do to keep you and them as safe as possible.

If you suspect you or a family member is having a stroke, don’t:

• Try to drive yourself or your loved one to the hospital — While you may think jumping into the car to get to the emergency room is quicker than waiting for an ambulance, that is not usually the case. Plus, if you're having a stroke, driving puts you and others around you at risk.
• Fall asleep — Keep yourself or your loved one awake and alert.
• Eat or drink anything — Stroke can affect a person's ability to swallow.
• Take medications — Taking the wrong medication can make a stroke worse.

What Happens at the Emergency Room for Stroke Treatment?

On the way to the hospital, the paramedics will radio the emergency room to let them know a patient with a suspected stroke is on the way.

Once you arrive at the hospital, ER doctors will take over your care to determine whether you’re having a stroke, what type of stroke it is and the best course of treatment.

Assessment and Diagnosis

The first thing ER staff will do when you arrive at the emergency room for stroke treatment is perform an initial assessment to analyze your symptoms and overall health:

• The ER will initiate a "code stroke" protocol that allows a medical team dedicated to treating strokes to provide a quick assessment of your symptoms and condition.
• Emergency room personnel will hook you up to machines that will take your vitals, such as heart rate and blood pressure, check your breathing and may start an IV line.
• Doctors will conduct a neurological exam to see how the stroke is affecting the brain, such as speech, balance and vision issues.
• ER personnel will take a blood sample, which can help them determine if you have an ischemic or hemorrhagic stroke.
• Your doctor may also utilize other diagnostic tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).

Once your doctor has a better understanding of the type of stroke and your health status, they will determine the best course of stroke treatment.

Diagnostic Tests for a Stroke

As previously mentioned, there are a variety of diagnostic tools that ER staff can use when diagnosing and treating a stroke. Keep reading to learn more about them.

Neurological Exam

Because a stroke is a disease of the brain, conducting a neurological exam can help doctors determine which areas of the brain are affected by the symptoms you have. Here are some examples:

• Frontal Lobe — A stroke affecting the frontal lobe of the brain can cause weakness in the arms and legs, speech issues, and motor control problems.
• Occipital Lobe — Vision issues are the result of a stroke influencing this brain area.
• Parietal Lobe — Spatial awareness, loss of senses, and language issues occur when a stroke impacts this area of the brain.
• Temporal Lobe — A stroke affecting this brain area can result in problems speaking and understanding speech, as well as hearing loss.

Blood Tests

When diagnosing a stroke in the emergency room, medical personnel frequently use blood tests to check the blood for a variety of health factors, such as:

• Blood count and overall health
• Blood glucose (sugar) levels
• Cholesterol levels
• Clotting ability is tested through Prothrombin Time (PT), Activated Partial Thromboplastic Time (aPTT), or D-dimer tests
• Electrolyte imbalance
• Infections

Imaging Tests

Depending on your health and situation, there are a variety of different imaging tests an ER doctor might use to confirm a stroke diagnosis. These imaging tests can help confirm the type of stroke your doctor believes you have and pinpoint where the blood clot or ruptured blood vessel is that caused the stroke.

Stroke diagnosis imaging tests include:

• Computed Tomography (CT) Scan: A CT scan is generally the first test your doctor will order. This is because it creates a detailed X-ray of the brain and can show if there's bleeding in the brain caused by a hemorrhagic stroke or brain damage caused by an ischemic stroke. Sometimes a doctor will perform a CT Angiography (CTA), which is when they place a special dye called contrast dye into your bloodstream. This can help doctors better see what is going on in your blood vessels.
• Magnetic Resonance Imaging (MRI): Another frequently ordered imaging test in an emergency room for stroke treatment is an MRI, which uses extremely strong magnets to create images of the brain. An MRI is more sensitive than a CT scan, which means it can sometimes even detect very early changes in the brain from a stroke. Like a CT scan, it allows doctors to visually see certain changes in the brain that can help them determine what type of stroke you have.
• Carotid Ultrasound: This test uses sound waves to make images of the carotid arteries, which are the blood vessels tasked with carrying blood to the brain. This ultrasound can help doctors see blood clots or blood flow issues, as well as cholesterol plaque build-up that can also clog vessels.
• CT Perfusion (CTP): This test is basically a series of CT scans or the brain taken after injecting a contrast dye into the bloodstream, which follows the dye as it travels through the brain's blood vessels. The data collected allows doctors to determine your cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) or the times it takes for the dye to travel through your brain.
• Transcranial Doppler Ultrasonography (TCD): The TCD test is another one that uses sound waves to create a picture, this time of the brain's major arteries. This allows doctors to see how well blood is flowing and to locate any issues.
• Positron Emission Tomography (PET): A PET scan uses an injected radioactive tracer into the bloodstream, which is then followed to create images of different activities going on in your body. For stroke, this scan can help doctors see the brain's active cells, damaged brain tissue areas, and any areas of slowed blood flow.
• Cerebral Angiography: Of all the imaging tests discussed thus far, this is probably the most invasive as it involves the insertion of a catheter into an artery that is guided to the brain's blood vessels. Once there, a contrast dye is injected and an X-ray of the brain's blood vessels is taken.

What Happens After the ER Visit?

Once the ER staff determines what type of stroke you have, administer necessary treatment and make sure you are stable — which can take anywhere from three to five hours — depending on your situation, you may be checked into a hospital stroke center for specialized care, or transferred to a rehabilitation center.

Hospital Stroke Center

A stroke center is designed especially to support people who have had a stroke. It is normally staffed by medical professionals specially trained to work with stroke survivors, such as neurologists, neurosurgeons and stroke nurses, as well as therapists and rehabilitation specialists.

Patients requiring intensive care after their stroke are sent to such a center, where they can receive specialized care for as long as needed, normally lasting about seven days.

The stroke center also provides various therapies and rehabilitation services for up to 28 days to help a stroke survivor regain some of the abilities they may have lost with their stroke, such as balance, coordination, speech and other daily living skills.

Rehabilitation Center

Some stroke survivors become very stable in the ER and can be transferred straight to a rehabilitation center. These patients need to be able to undergo at least three hours of therapy each day for five days a week.

How long a person remains at a stroke rehab center depends on several factors, including their age, the type and severity of their stroke, and how well they respond to therapy. Generally speaking, residency at a rehab center normally lasts between three and six weeks.

A rehab center provides an array of different therapies for stroke survivors to help them get back to as normal a life as possible, including:

• Physical Therapy: This type of therapy helps stroke survivors regain strength in the limbs, as well as improve their coordination and balance.
• Occupational Therapy: Focuses on the skills that a person needs to function in their daily lifestyle, such as bathing, eating, dressing, cooking, cleaning, problem-solving, and memory.
• Speech and Language Therapy: As loss of speech is a main symptom of a stroke, this type of therapy helps stroke survivors regain their ability to speak, as well as help correct any swallowing issues they may have developed from their stroke.
• Cognitive Rehabilitation: A stroke has a major impact on your brain and how well it functions. This type of rehab helps a person regain their cognitive functions, like memory and problem-solving, through different therapies and therapeutic activities.
• Psychological Support: Having a stroke is a traumatic, life-changing experience, which can lead to mental health issues such as depression, anxiety, post-traumatic stress disorder (PTSD) and changes to a person's personality. Different psychological and psychiatric therapies can be used to help in these situations.

It's important to note that even if a stroke survivor can be discharged from an inpatient rehabilitation center, there is a good chance they will still undergo outpatient therapies, either at their home or a rehab center, for a few months to a year.

Lifestyle Changes

About a quarter of all people who experience a stroke will have a second one. To aid in your recovery and help prevent a secondary stroke from occurring, there are several lifestyle changes that stroke survivors need to make to keep themselves healthy:

• Dietary Changes — Stroke survivors are advised to choose a heart-healthy diet that focuses on fruits, vegetables, whole grains and lean proteins, while minimizing sodium, alcohol and ultra-processed foods.
• Exercise — In addition to any outpatient rehab, stroke survivors are urged to get 20 to 60 minutes of aerobic exercise — such as walking or swimming — three to five days a week, and strength training using light weights or resistance bands two to three days a week.
• Quit Smoking — Studies show that continuing to smoke after a stroke can place you at a high risk for another stroke.
• Maintaining a Healthy Weight — Obesity can raise your risk for a secondary stroke, as well as heart disease and type 2 diabetes, which are also known risk factors for stroke.
• Stress Management — Stress is a known risk factor for stroke, and can increase your risk for having another one when not managed correctly. Lower your stress by practicing relaxation techniques like meditation or yoga, getting enough sleep, picking up a new hobby or finding a support group.

Treatment Options for Stroke

Emergency room stroke treatments are determined by the type of stroke you have, the severity of your stroke and your overall health. There are several medications used through neurology care to treat stroke, as well as surgical options depending on your situation.

Ischemic Stroke Treatment

With an ischemic stroke, doctors want to bust the blood clot, keeping blood from reaching your brain as quickly as possible. To do this, they will use medications such as thrombolytics, such as tissue plasminogen activator (tPA), to remove the clot.

Doctors may also use a physical way to remove a blood clot, which is called mechanical thrombectomy. In this procedure, a catheter is inserted and guided to where the clot is located. Then, the clot is removed using the catheter.

Additionally, your doctor may prescribe you additional medications, including anticoagulants and antiplatelets, to keep more blood clots from forming, as well as medication to manage your blood pressure.

Hemorrhagic Stroke Treatment

When treating a hemorrhagic stroke in the emergency room, the main goal is to stop blood from flooding the brain and repair the ruptured blood vessel.

Blood pressure medications or blood thinners are used to help stop the bleeding. You may also receive drugs to manage pain and seizures.

If medications do not sufficiently stop the bleeding, surgical options may be deployed, such as surgical clipping, where a metal clip is positioned at the base of a weakened artery to stop the bleeding. Weakened arteries — known as aneurysms — can also be fixed using less invasive procedures such as endovascular embolization.

For very severe hemorrhagic strokes, a craniotomy may be required to slightly open the skull to remove blood that has flooded in, creating too much pressure on the brain.

Prevention and Risk Factors

Thankfully, there are things you can do right now to help prevent you or a loved one from needing emergency room stroke treatment.

While there are some non-changeable risk factors for stroke, such as age, gender, and family history, there are some modifiable risk factors that, if you change now, may help prevent you from having a stroke in the future, such as:

• Excessive alcohol or illegal drug use
• High blood pressure
• High LDL or “bad” cholesterol levels
• Obesity
• Sedentary lifestyle
• Sleeping issues
• Smoking
• Type 2 diabetes

There are also some preventative measures you and your loved ones can start today to help prevent a stroke tomorrow, including:

• Adhering to medications to help prevent stroke or manage conditions that are stroke risk factors
• Being more physically active
• Eating a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet
• Limiting alcohol use
• Maintaining a healthy weight
• Managing your blood pressure and cholesterol levels
• Quitting smoking
• Reducing stress
• Visiting your AdventHealth primary care physician (PCP) for annual check-ups

AdventHealth for Stroke Care: Timely Action Saves Lives

When dealing with a suspected stroke, every minute counts for the best possible outcome. Knowing how to “BE-FAST” in recognizing stroke symptoms and what to expect for emergency room stroke treatment are crucial, so you can be prepared to act quickly and calmly.

And the good news is you can help protect yourself and your loved ones from having a stroke by knowing the right prevention strategies and modifiable risk factors.

If you have questions regarding AdventHealth’s stroke care and rehabilitation services, contact us today.