Mrs. Smith is an 84 year old resident of a long term care facility. She has a history of heart failure and is in chronic atrial fibrillation. Her medications include daily Coumadin. She is normally alert and able to accomplish most of her activities of daily living on her own. The most important consideration during the acute phase of the stroke is .

The first priority in acute management of the patient with a stroke is the preservation of life. Because the patient of a stroke may be unconscious or have a reduced gag reflex, it is most important to maintain a patent airway for the patient and provide oxygen if respiratory effort is impaired. IV fluid replacement, treatment with osmotic diuretics, and avoiding hyperthermia may be used for further treatment.

Stroke care may be organized at three levels - a basic stroke care facility, a primary stroke care facility and a comprehensive stroke care facility. The basic stroke care facility should be the minimum setup at district hospitals; primary stroke care facility should be mandatory for all medical colleges and multispeciality hospitals; and well-equipped hospitals including some medical colleges should develop comprehensive stroke care facilities. The basic stroke facility may not have artificial ventilators, echocardiography and carotid Doppler facility, primary stroke care facilities may have these facilities but not neurosurgery, MRI or angiography. Comprehensive stroke care facilities should have all these facilities.

Stroke management is multiprofessional and interprofessional not only in its entirety of the pathway but also sections of the pathway such as the management of swallowing problems. Good practice dictates that people admitted to hospital with an acute stroke should be managed on a stroke unit.

Stroke units are clinical areas dedicated to the care of people admitted to hospital with stroke. Stroke units are staffed by professionals with an interest in and knowledge of stroke. Evidence has shown that people cared for on stroke units recover better and are less likely to die both in the short and long terms (odds of death 0.82; 95% CI, 0.77 to 0.87; P0.00001) [7,

Explanation:

The most important thing to keep in mind about the stroke is the area in which the brain is affected, if it is an ischemic or hemorrhagic stroke since if it is hemorrhagic it is necessary to decompress the area and restrain the bleeding, and the etiology of the stroke if it is embolo bacterial or thrombus, or by blood hypercoagulation.

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