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In April 2022, the UK National Institute for Health and Clinical Excellence (NICE) updated guidelines for the diagnosis and initial management of stroke and transient ischemic attack in people over 16 years of a.
The main content of the guideline covers acute-phase interventions for stroke and transient ischemic attack (TI.
Today is May 25, "World Stroke Prevention Day", let's learn the latest guidelines togeth.
Compiled and organized by Yimaitong, please do not reprint without authorizati.
Rapid identification of symptoms and diagnosis ➤ Prompt recognition of stroke and TIA symptoms ➤ Ischemic attack ➤ Use of validated tools, such as FAST, outside the hospital to screen people with sudden onset of neurological symptoms to diagnose stroke or T.
➤ Exclude causes such as hypoglycemia in people with sudden onset of neurological sympto.
➤ For emergency patients with suspected stroke or TIA, use a validated tool to rapidly establish a diagnosis, such as ROSIER (Stroke Recognition in the Emergency Roo.
➤Initial management of suspected and confirmed TIA ➤Unless there are contraindications, patients with suspected TIA should start taking aspirin (300mg/d) immediate.
➤ Patients with suspected TIA should be immediately referred to a specialist for evaluation and investigation within 24 hours of symptom ons.
➤ Do not use scoring systems, such as ABCD2, to assess the risk of subsequent stroke or to inform the urgency of referral for patients with suspected or confirmed T.
➤ Provide secondary prevention in addition to aspirin as soon as possible after TIA is diagnos.
Imaging in Patients With Suspected TIA or Acute Nondisabling Stroke ➤ Suspected TIA ➤ Do not perform brain CT scans in patients with suspected TIA unless there is clinical suspicion of a CT-detectable alternative diagnos.
➤Consider MRI (including MRI and SWI) to identify ischemic areas, or to detect hemorrhage or other pathology, following expert evaluation at T.
➤Carotid artery imaging ➤In patients with TIA, carotid artery imaging should be performed immediately in patients who have been assessed by experts to be candidates for carotid endarterecto.
➤Emergency carotid endarterectomy ➤Ensure neurological stabilization in patients with acute nondisabling stroke or TIA, with symptomatic carotid stenosis of 50%-99% according to NASCET (North American Symptomatic Carotid Endarterectomy Tria.
Evaluation of carotid endarterectomy according to current national standards (NHS England Code of Neurointerventional Services for Acute Ischemic and Hemorrhagic Stroke) and urgent referral to appropriate and drugs to lower cholesterol, life>
Specialty Care of Patients with Acute Stroke ➤ Specialized Stroke Unit ➤ Refer all patients with suspected stroke directly to the Specialized Stroke Unit after initial assessment in the community, emergency department, or outpatient clin.
(The acute stroke unit is a separate area of the hospital made up of a multidisciplinary team of stroke specialis.
It can use equipment to monitor and rehabilitate patien.
Hold regular multidisciplinary team meetings to set goal.
➤Early evaluation of patients with suspected acute cerebral stroke by brain imaging ➤If any of the following conditions, head CT scan should be performed immediately for those suspected of acute stroke: thrombolysis or thrombectomy indications Anticoagulation therapy Known level of consciousness of bleeding tendency Decreased (Glasgow Coma Scale less than 13) Progressive or fluctuating symptoms of unknown cause Papilledema, neck stiffness, or fev.
Add CT perfusion imaging or MR if thrombectomy is likely to be required after 6 hours after symptom ons.
➤In patients with suspected acute stroke but no indication for immediate brain imaging, scans should be performed as soon as possible within 24 hours of symptom ons.
Drug therapy and thrombectomy in patients with acute ischemic stroke ➤ Thrombolytic therapy with alteplase in patients with acute ischemic stroke Stroke: Initiate treatment as soon as possible within 5 hours of stroke symptom onset Exclude intracranial hemorrhage with appropriate imaging techniques This recommendation comes from the NICE technical assessment guideline for alteplase in acute ischemic stro.
➤ Use alteplase only in well-organized stroke centers, including: Staff trained in thrombolysis and monitoring of thrombolysis-related complications Nursing staff trained in acute stroke and thrombolysis to provide Level 1 and Immediate access to imaging and re-imaging at level 2 care, as well as staff trained in image interpretation ➤ Emergency department staff, with appropriate training and support, can use alteplase for ischemic stroke, provided the patient Appropriate neuroradiology and neurology physicians can be supported in acute stroke servic.
➤ Ensure that a protocol for the implementation and management of intravenous thrombolysis is in place, including post-thrombotic complicatio.
➤Thrombectomy in patients with acute ischemic stroke Proximal anterior circulation occlusion confirmed by CT angiography (CTA) or magnetic resonance angiography (MRA) in acute ischemic stroke ➤ Provided as soon as possible to patients who were last confirmed healthy (including waking stroke) within 6 hours to 24 hours Thrombectomy: In patients with acute ischemic stroke, CTA or MRA-confirmed proximal anterior circulation occlusion such as CT perfusion imaging or MRI sequence showing limited infarct core volume e.
Imaging shows the possibility of salvage brain tissue ➤ For recently known Thrombectomy and intravenous thrombolysis should be considered as soon as possible (if not contraindicated, and within a permissible time window) in patients who are healthy for the previous 24 hours (including wake-up stroke): with acute ischemic stroke, Proximal posterior circulation .
basilar or posterior cerebral artery) occlusion confirmed by CTA or MRA Imaging such as CT perfusion imaging or MRI sequence showing limited infarct core volume to indicate whether brain tissue is likely to be rescued ➤ At the time of initial brain imaging, Consideration of the patient's overall clinical status and established infarct size to decide whether to remove thrombecto.
Select patients with the following conditions (in addition to the factors suggested by the 3 above): Pre-stroke functional status less than 3 points on the modified Rankin scale National Institutes of Health Stroke Scale (NIHSS) score of more than 5 points ➤ Aspirin Treatment with anticoagulation ➤ Patients with acute ischemic stroke ➤ All patients diagnosed with acute stroke and bleeding excluded by brain imaging should be offered the following as soon as possible within 24 hours: Oral aspirin 300 mg if there is no dysphagia If dysphagia is present, Aspirin 300 mg via gastric tube can be given and continued aspirin 300 mg per day until 2 weeks after stroke symptoms, at which point definitive long-term antithrombotic therapy is initiat.
If the patient is discharged before 2 weeks, long-term treatment should be started as soon as possib.
➤ In addition to aspirin, provide a proton pump inhibitor to any patient with acute ischemic stroke who has had a history of aspirin-related gastrointestinal reactio.
➤Provide alternative antiplatelet drugs to patients with acute ischemic stroke who are allergic or truly intolerant to aspir.
(Aspirin intolerance is defined as any of the following: hypersensitivity to aspirin-containing drugs, or severe gastrointestinal reactions caused by low-dose aspir.
) ➤ Anticoagulation is not routinely used in the treatment of acute stro.
➤ Patients with acute venous stroke ➤ Provide full-dose anticoagulation (initially full-dose heparin, then warfarin [international normalized ratio 2:3]) to patients diagnosed with cerebral venous sinus thrombosis, including secondary intracerebral hemorrhage ]), unless comorbidities preclude its u.
➤ Patients with stroke associated with arterial dissection ➤ Administer anticoagulant or antiplatelet therapy to patients with stroke secondary to acute arterial dissecti.
➤ Patients with acute ischemic stroke associated with antiphospholipid syndrome ➤ Treat acute ischemic stroke with antiphospholipid syndrome in the same way as acute ischemic stroke without antiphospholipid syndro.
➤Reversal of anticoagulation in hemorrhagic stroke ➤In patients with primary cerebral hemorrhage who received warfarin before stroke, the blood coagulation level returned to normal as soon as possib.
The effects of warfarin were reversed by a combination of prothrombin complex concentrate and intravenous vitami.
➤Anticoagulation for other comorbidities ➤Ensure that patients with disabling ischemic stroke and atrial fibrillation take aspirin 300 mg for the first 2 weeks before anticoagulation is consider.
➤ For prosthetic valve replacement patients with disabling cerebral infarction and significant risk of hemorrhagic transformation, stop anticoagulation for 1 week and switch to aspirin 300 .
➤ Ensure that patients with ischemic stroke and symptomatic proximal deep vein thrombosis or pulmonary embolism are given priority to anticoagulation over aspirin unless there are other contraindications to anticoagulati.
➤ In people with hemorrhagic stroke and symptomatic deep vein thrombosis or pulmonary embolism, use anticoagulation or a vena cava filter to prevent further development of pulmonary emboli.
➤Statin therapy ➤Statin therapy is not recommended immediately in patients with acute stro.
➤Continue statin therapy for acute stroke patients already receiving statin thera.
Maintain or restore homeostasis ➤ Supplemental oxygen therapy ➤ Supplemental oxygen should be administered to stroke patients only when blood oxygen saturation is below 9
Conventional supplemental oxygen is not recommended for acute stroke patients without hypox.
➤Glycemic control ➤Maintain blood glucose concentrations between 4 and 11 mmol/L in acute stroke patien.
➤ Provide optimal insulin therapy to all adults with type 1 diabetes with aura or actual stroke, which can be achieved with intravenous insulin and gluco.
Intensive care and emergency departments should have such management optio.
➤Blood pressure control in patients with acute intracerebral hemorrhage between the colum.
➤ Rapid blood pressure reduction should be considered in patients with acute intracerebral hemorrhage who do not have any of the exclusions listed in the recommendations below: onset of symptoms for more than 6 hours or systolic blood pressure greater than 220 mm.
➤When rapidly reducing blood pressure in patients with acute cerebral hemorrhage, the systolic blood pressure should reach 140 mmHg or lower within 1 hour after starting treatment, while ensuring that the drop does not exceed 60 mm.
➤ Rapid blood pressure lowering is not available for those with an underlying structural cause (eg, tumor, arteriovenous malformation, or aneurysm) Glasgow coma score less than 6, early neurosurgery to remove hematoma, large hematoma, poor prognosis expected ➤ Consult a pediatrician when considering lowering blood pressure in young adults 16 or 17 years of age with acute intracerebral hemorrhage who do not have any of the exclusions listed in the recommendations abo.
➤ Blood pressure control in patients with acute ischemic stroke Nephrotic Hypertensive Heart Failure/Myocardial Infarction Aortic Dissection Pre-eclampsia/Eclampsia ➤ Consider lowering blood pressure to 185/110 mmHg or lower in patients requiring intravenous thrombolys.
Nutritional support and hydration ➤ Assessment of swallowing function ➤ On admission, ensure acute stroke patients are screened for swallowing by appropriately trained medical professionals before receiving any oral food, fluid, or medicati.
➤ If admission screening shows swallowing problems, ensure that the patient undergoes a swallowing assessment by a specialist, preferably within 24 hours and no more than 72 hours after admissi.
➤ People who are suspected of having aspiration as assessed by an expert, or who require tube feeding or dietary modification for 3 days, should: Re-evaluate and consider instrumentation Refer to the dietary recommendations below ➤ Acute stroke patients who cannot receive adequate oral nutrition, fluids, and medications Should: Receive nasogastric tube feeding within 24 hours of admission, unless thrombolytic therapy is given If patient cannot tolerate nasogastric tube, consider nasoenteric tube or gastrostomy Consult an appropriately trained medical professional for Detailed nutritional assessments, individualized recommendations and monitoring review their oral medications to modify formulation or route of administrati.
➤ Oral nutritional supplements ➤ Screen all hospitalized patients for malnutrition and malnutrition risk upon admissi.
Screening of hospitalized patients was repeated week.
➤ Screening should assess body mass index (BMI) and percent unintended weight loss
The timing of unexpected reductions in nutrient intake and/or the possibility of impaired nutrient intake in the future should also be consider.
For example, this can be done using the Malnutrition Universal Screening Tool (MUS.
➤ When screening for malnutrition and malnutrition risk, be aware that dysphagia, poor oral health, and reduced self-feeding ability can affect nutrition in stroke patien.
➤ Screening for malnutrition and malnutrition risk should be performed by medical professionals with appropriate skills and traini.
➤ Routine nutritional supplementation is not recommended for acute stroke patients with adequate nutrition on admissi.
➤ Nutritional support for stroke patients at risk of malnutriti.
This may include oral nutritional supplements, expert dietary advice, and/or tube feedi.
➤ Hydration ➤ On admission, assess hydration in acute stroke patien.
Check and manage hydration regularly to maintain normal hydrati.
Optimal Positioning and Early Mobility ➤ Optimal Positioning for Acute Stroke Patients ➤ Assess the individual clinical needs and personal preferences of acute stroke patients to determine their optimal head positi.
Consider factors such as their comfort level, physical and cognitive abilities, and postural contr.
➤Early mobilization ➤As part of an active management program in a stroke specialist unit, assist acute stroke patients to sit up, stand, or walk as soon as clinically possib.
➤ If the patient needs assistance to get out of bed, stand, or walk, do not engage in high-intensity exercise for the first 24 hours after symptoms appe.
Avoiding Aspiration Pneumonia ➤ To avoid aspiration pneumonia, provide patients with dysphagia with food, fluids, and medications that can be swallowed without aspiration under the guidance of a speciali.
Compiled from: Stroke and transient ischaemic attack in over 16s: diagnosis and initial manageme.
London: National Institute for Health and Care Excellence (NICE); 2019 MayPMID: 3121153
The main content of the guideline covers acute-phase interventions for stroke and transient ischemic attack (TI.
Today is May 25, "World Stroke Prevention Day", let's learn the latest guidelines togeth.
Compiled and organized by Yimaitong, please do not reprint without authorizati.
Rapid identification of symptoms and diagnosis ➤ Prompt recognition of stroke and TIA symptoms ➤ Ischemic attack ➤ Use of validated tools, such as FAST, outside the hospital to screen people with sudden onset of neurological symptoms to diagnose stroke or T.
➤ Exclude causes such as hypoglycemia in people with sudden onset of neurological sympto.
➤ For emergency patients with suspected stroke or TIA, use a validated tool to rapidly establish a diagnosis, such as ROSIER (Stroke Recognition in the Emergency Roo.
➤Initial management of suspected and confirmed TIA ➤Unless there are contraindications, patients with suspected TIA should start taking aspirin (300mg/d) immediate.
➤ Patients with suspected TIA should be immediately referred to a specialist for evaluation and investigation within 24 hours of symptom ons.
➤ Do not use scoring systems, such as ABCD2, to assess the risk of subsequent stroke or to inform the urgency of referral for patients with suspected or confirmed T.
➤ Provide secondary prevention in addition to aspirin as soon as possible after TIA is diagnos.
Imaging in Patients With Suspected TIA or Acute Nondisabling Stroke ➤ Suspected TIA ➤ Do not perform brain CT scans in patients with suspected TIA unless there is clinical suspicion of a CT-detectable alternative diagnos.
➤Consider MRI (including MRI and SWI) to identify ischemic areas, or to detect hemorrhage or other pathology, following expert evaluation at T.
➤Carotid artery imaging ➤In patients with TIA, carotid artery imaging should be performed immediately in patients who have been assessed by experts to be candidates for carotid endarterecto.
➤Emergency carotid endarterectomy ➤Ensure neurological stabilization in patients with acute nondisabling stroke or TIA, with symptomatic carotid stenosis of 50%-99% according to NASCET (North American Symptomatic Carotid Endarterectomy Tria.
Evaluation of carotid endarterectomy according to current national standards (NHS England Code of Neurointerventional Services for Acute Ischemic and Hemorrhagic Stroke) and urgent referral to appropriate and drugs to lower cholesterol, life>
Specialty Care of Patients with Acute Stroke ➤ Specialized Stroke Unit ➤ Refer all patients with suspected stroke directly to the Specialized Stroke Unit after initial assessment in the community, emergency department, or outpatient clin.
(The acute stroke unit is a separate area of the hospital made up of a multidisciplinary team of stroke specialis.
It can use equipment to monitor and rehabilitate patien.
Hold regular multidisciplinary team meetings to set goal.
➤Early evaluation of patients with suspected acute cerebral stroke by brain imaging ➤If any of the following conditions, head CT scan should be performed immediately for those suspected of acute stroke: thrombolysis or thrombectomy indications Anticoagulation therapy Known level of consciousness of bleeding tendency Decreased (Glasgow Coma Scale less than 13) Progressive or fluctuating symptoms of unknown cause Papilledema, neck stiffness, or fev.
Add CT perfusion imaging or MR if thrombectomy is likely to be required after 6 hours after symptom ons.
➤In patients with suspected acute stroke but no indication for immediate brain imaging, scans should be performed as soon as possible within 24 hours of symptom ons.
Drug therapy and thrombectomy in patients with acute ischemic stroke ➤ Thrombolytic therapy with alteplase in patients with acute ischemic stroke Stroke: Initiate treatment as soon as possible within 5 hours of stroke symptom onset Exclude intracranial hemorrhage with appropriate imaging techniques This recommendation comes from the NICE technical assessment guideline for alteplase in acute ischemic stro.
➤ Use alteplase only in well-organized stroke centers, including: Staff trained in thrombolysis and monitoring of thrombolysis-related complications Nursing staff trained in acute stroke and thrombolysis to provide Level 1 and Immediate access to imaging and re-imaging at level 2 care, as well as staff trained in image interpretation ➤ Emergency department staff, with appropriate training and support, can use alteplase for ischemic stroke, provided the patient Appropriate neuroradiology and neurology physicians can be supported in acute stroke servic.
➤ Ensure that a protocol for the implementation and management of intravenous thrombolysis is in place, including post-thrombotic complicatio.
➤Thrombectomy in patients with acute ischemic stroke Proximal anterior circulation occlusion confirmed by CT angiography (CTA) or magnetic resonance angiography (MRA) in acute ischemic stroke ➤ Provided as soon as possible to patients who were last confirmed healthy (including waking stroke) within 6 hours to 24 hours Thrombectomy: In patients with acute ischemic stroke, CTA or MRA-confirmed proximal anterior circulation occlusion such as CT perfusion imaging or MRI sequence showing limited infarct core volume e.
Imaging shows the possibility of salvage brain tissue ➤ For recently known Thrombectomy and intravenous thrombolysis should be considered as soon as possible (if not contraindicated, and within a permissible time window) in patients who are healthy for the previous 24 hours (including wake-up stroke): with acute ischemic stroke, Proximal posterior circulation .
basilar or posterior cerebral artery) occlusion confirmed by CTA or MRA Imaging such as CT perfusion imaging or MRI sequence showing limited infarct core volume to indicate whether brain tissue is likely to be rescued ➤ At the time of initial brain imaging, Consideration of the patient's overall clinical status and established infarct size to decide whether to remove thrombecto.
Select patients with the following conditions (in addition to the factors suggested by the 3 above): Pre-stroke functional status less than 3 points on the modified Rankin scale National Institutes of Health Stroke Scale (NIHSS) score of more than 5 points ➤ Aspirin Treatment with anticoagulation ➤ Patients with acute ischemic stroke ➤ All patients diagnosed with acute stroke and bleeding excluded by brain imaging should be offered the following as soon as possible within 24 hours: Oral aspirin 300 mg if there is no dysphagia If dysphagia is present, Aspirin 300 mg via gastric tube can be given and continued aspirin 300 mg per day until 2 weeks after stroke symptoms, at which point definitive long-term antithrombotic therapy is initiat.
If the patient is discharged before 2 weeks, long-term treatment should be started as soon as possib.
➤ In addition to aspirin, provide a proton pump inhibitor to any patient with acute ischemic stroke who has had a history of aspirin-related gastrointestinal reactio.
➤Provide alternative antiplatelet drugs to patients with acute ischemic stroke who are allergic or truly intolerant to aspir.
(Aspirin intolerance is defined as any of the following: hypersensitivity to aspirin-containing drugs, or severe gastrointestinal reactions caused by low-dose aspir.
) ➤ Anticoagulation is not routinely used in the treatment of acute stro.
➤ Patients with acute venous stroke ➤ Provide full-dose anticoagulation (initially full-dose heparin, then warfarin [international normalized ratio 2:3]) to patients diagnosed with cerebral venous sinus thrombosis, including secondary intracerebral hemorrhage ]), unless comorbidities preclude its u.
➤ Patients with stroke associated with arterial dissection ➤ Administer anticoagulant or antiplatelet therapy to patients with stroke secondary to acute arterial dissecti.
➤ Patients with acute ischemic stroke associated with antiphospholipid syndrome ➤ Treat acute ischemic stroke with antiphospholipid syndrome in the same way as acute ischemic stroke without antiphospholipid syndro.
➤Reversal of anticoagulation in hemorrhagic stroke ➤In patients with primary cerebral hemorrhage who received warfarin before stroke, the blood coagulation level returned to normal as soon as possib.
The effects of warfarin were reversed by a combination of prothrombin complex concentrate and intravenous vitami.
➤Anticoagulation for other comorbidities ➤Ensure that patients with disabling ischemic stroke and atrial fibrillation take aspirin 300 mg for the first 2 weeks before anticoagulation is consider.
➤ For prosthetic valve replacement patients with disabling cerebral infarction and significant risk of hemorrhagic transformation, stop anticoagulation for 1 week and switch to aspirin 300 .
➤ Ensure that patients with ischemic stroke and symptomatic proximal deep vein thrombosis or pulmonary embolism are given priority to anticoagulation over aspirin unless there are other contraindications to anticoagulati.
➤ In people with hemorrhagic stroke and symptomatic deep vein thrombosis or pulmonary embolism, use anticoagulation or a vena cava filter to prevent further development of pulmonary emboli.
➤Statin therapy ➤Statin therapy is not recommended immediately in patients with acute stro.
➤Continue statin therapy for acute stroke patients already receiving statin thera.
Maintain or restore homeostasis ➤ Supplemental oxygen therapy ➤ Supplemental oxygen should be administered to stroke patients only when blood oxygen saturation is below 9
Conventional supplemental oxygen is not recommended for acute stroke patients without hypox.
➤Glycemic control ➤Maintain blood glucose concentrations between 4 and 11 mmol/L in acute stroke patien.
➤ Provide optimal insulin therapy to all adults with type 1 diabetes with aura or actual stroke, which can be achieved with intravenous insulin and gluco.
Intensive care and emergency departments should have such management optio.
➤Blood pressure control in patients with acute intracerebral hemorrhage between the colum.
➤ Rapid blood pressure reduction should be considered in patients with acute intracerebral hemorrhage who do not have any of the exclusions listed in the recommendations below: onset of symptoms for more than 6 hours or systolic blood pressure greater than 220 mm.
➤When rapidly reducing blood pressure in patients with acute cerebral hemorrhage, the systolic blood pressure should reach 140 mmHg or lower within 1 hour after starting treatment, while ensuring that the drop does not exceed 60 mm.
➤ Rapid blood pressure lowering is not available for those with an underlying structural cause (eg, tumor, arteriovenous malformation, or aneurysm) Glasgow coma score less than 6, early neurosurgery to remove hematoma, large hematoma, poor prognosis expected ➤ Consult a pediatrician when considering lowering blood pressure in young adults 16 or 17 years of age with acute intracerebral hemorrhage who do not have any of the exclusions listed in the recommendations abo.
➤ Blood pressure control in patients with acute ischemic stroke Nephrotic Hypertensive Heart Failure/Myocardial Infarction Aortic Dissection Pre-eclampsia/Eclampsia ➤ Consider lowering blood pressure to 185/110 mmHg or lower in patients requiring intravenous thrombolys.
Nutritional support and hydration ➤ Assessment of swallowing function ➤ On admission, ensure acute stroke patients are screened for swallowing by appropriately trained medical professionals before receiving any oral food, fluid, or medicati.
➤ If admission screening shows swallowing problems, ensure that the patient undergoes a swallowing assessment by a specialist, preferably within 24 hours and no more than 72 hours after admissi.
➤ People who are suspected of having aspiration as assessed by an expert, or who require tube feeding or dietary modification for 3 days, should: Re-evaluate and consider instrumentation Refer to the dietary recommendations below ➤ Acute stroke patients who cannot receive adequate oral nutrition, fluids, and medications Should: Receive nasogastric tube feeding within 24 hours of admission, unless thrombolytic therapy is given If patient cannot tolerate nasogastric tube, consider nasoenteric tube or gastrostomy Consult an appropriately trained medical professional for Detailed nutritional assessments, individualized recommendations and monitoring review their oral medications to modify formulation or route of administrati.
➤ Oral nutritional supplements ➤ Screen all hospitalized patients for malnutrition and malnutrition risk upon admissi.
Screening of hospitalized patients was repeated week.
➤ Screening should assess body mass index (BMI) and percent unintended weight loss
The timing of unexpected reductions in nutrient intake and/or the possibility of impaired nutrient intake in the future should also be consider.
For example, this can be done using the Malnutrition Universal Screening Tool (MUS.
➤ When screening for malnutrition and malnutrition risk, be aware that dysphagia, poor oral health, and reduced self-feeding ability can affect nutrition in stroke patien.
➤ Screening for malnutrition and malnutrition risk should be performed by medical professionals with appropriate skills and traini.
➤ Routine nutritional supplementation is not recommended for acute stroke patients with adequate nutrition on admissi.
➤ Nutritional support for stroke patients at risk of malnutriti.
This may include oral nutritional supplements, expert dietary advice, and/or tube feedi.
➤ Hydration ➤ On admission, assess hydration in acute stroke patien.
Check and manage hydration regularly to maintain normal hydrati.
Optimal Positioning and Early Mobility ➤ Optimal Positioning for Acute Stroke Patients ➤ Assess the individual clinical needs and personal preferences of acute stroke patients to determine their optimal head positi.
Consider factors such as their comfort level, physical and cognitive abilities, and postural contr.
➤Early mobilization ➤As part of an active management program in a stroke specialist unit, assist acute stroke patients to sit up, stand, or walk as soon as clinically possib.
➤ If the patient needs assistance to get out of bed, stand, or walk, do not engage in high-intensity exercise for the first 24 hours after symptoms appe.
Avoiding Aspiration Pneumonia ➤ To avoid aspiration pneumonia, provide patients with dysphagia with food, fluids, and medications that can be swallowed without aspiration under the guidance of a speciali.
Compiled from: Stroke and transient ischaemic attack in over 16s: diagnosis and initial manageme.
London: National Institute for Health and Care Excellence (NICE); 2019 MayPMID: 3121153
