Ischemic Stroke: Guidelines & Treatment

Instructor: Tari Rajchel

Tari has been a Registered Nurse for 29 years and has her Docotorate in Nursing Practice.

Ischemic strokes are serious medical emergencies and require immediate medical attention. There is a 'Golden Hour' that is pivotal in the treatment of ischemic strokes. In this lesson we will review the guidelines and treatments for ischemic strokes.

Think FAST

You are at a family picnic and notice your grandmother sitting in a chair by herself. As you approach you notice her face is drooping, and when you ask her what is wrong she is having trouble answering you. Think FAST, which is an easy way to remember the signs of a stroke.

  • F= face drooping. ask the person to smile. Is the smile uneven?
  • A= arm weakness. Is one arm weak or numb? Ask the person to raise both arms; does one slowly fall back down?
  • S= speech difficulty. Is the speech slurred or is the person having trouble speaking or is hard to understand?
  • T= time to call 911. If you notice any of the above symptoms call 911.

Ischemic Stroke

An ischemic stroke occurs when there is a sudden loss of blood flow, from an obstruction, to a specific area of the brain that results in loss of different bodily functions. There are two types of obstructions: thrombosis and embolism. A thrombosis is where a clot forms in the blood vessel in the brain and obstructs blood flow. An embolism is where a clot forms in another part of the body, breaks loose and travels to the brain where it gets stuck in a smaller vessel and blocks blood flow.

Image of Ischemic Stroke
Ischemic stroke


The goal of treatment for an ischemic stroke is to restore blood flow to the affected area of the brain as fast as possible, during a time frame many refer to as 'The Golden Hour'. Many people do not know the importance of early medical attention, so educating on early signs and symptoms will get stroke victims faster medical care and will lead to better outcomes. Specific guidelines for care help ensure the fastest possible treatment for stroke patients.

Emergency Medical Services (EMS)

The American Heart Association/American Stroke Association has put out specific guidelines for Emergency Medical Services around stroke care. A call that comes in for a stroke patient should receive top priority and follow these guidelines:

  • The highest level of care in the shortest time possible
  • Time from call to dispatch < 90 seconds
  • Time from dispatch to arrival on scene < 8 minutes
  • Dispatch time < 1 minute
  • On scene time < 15 minutes

The goal for EMS is to perform rapid evaluation, early recognition, stabilization, and rapid transport to a stroke-ready hospital. Many hospitals are designation certified stroke centers and are equipped to manage stroke patients. EMS also needs to call ahead to alert the hospital they are bringing in a stroke patient. This will allow the hospital to activate their stroke team.

Hospital and Treatments

Hospitals need to have protocols set up to quickly evaluate a patient who is suspected of having a stroke. The goal is to do a complete evaluation and start fibrinolytic (rtPA) treatment within 60 minutes of the patient arriving to the hospital. The use of rtPA (recombinant tissue plasminogen activator) has become the standard treatment over the last several years for patients presenting with ischemic stroke symptoms. Fibrinolytic (rtPA) treatment is a medication that is put through a patient's vein and is used to break up the clot that is preventing blood from reaching the brain and causing the stroke. There is a short window of time that this medication can be used; it must be given within 60 minutes of arrival to the hospital. This is why there is a reference for stroke patients of the 'Golden Hour'. The protocol below outlines the guidelines, including which tests should not delay the initiation of the rtPA medication treatment. The protocol should include:

  • Use of a stroke rating scale (preferably the NIHSS - National Institutes of Health Stroke Scale).
  • Blood glucose testing prior to initiation of rtPA.
  • Limited lab tests (CBC- complete blood count, electrolytes, coagulation studies).
  • Baseline EKG recommended, but should NOT delay initiation of rtPA.
  • Baseline troponin, but should NOT delay initiation of rtPA.
  • CT or MRI is recommended prior to rtPA to rule out intracerebral hemorrhage. Brain imaging studies need to be interpreted within 45 minutes of patient's arrival
  • IV rtPA (Fibrinolysis treatment) beginning within 60 minutes of arrival to hospital.
  • Regulate high blood pressure.

On-going Care

Your grandmother has recovered from her stroke and has returned home. Patients who are survivors of an ischemic stroke are at greater risk for additional strokes. It will be important for your grandmother and family to help in the prevention and management of risk factors related to ischemic stroke. Controlling high blood pressure is very important. Blood pressure screening and treatment is recommended for prevention of recurrent stroke in patients who have had an ischemic stroke.

To unlock this lesson you must be a Member.
Create your account

Register to view this lesson

Are you a student or a teacher?

Unlock Your Education

See for yourself why 30 million people use

Become a member and start learning now.
Become a Member  Back
What teachers are saying about
Try it risk-free for 30 days

Earning College Credit

Did you know… We have over 200 college courses that prepare you to earn credit by exam that is accepted by over 1,500 colleges and universities. You can test out of the first two years of college and save thousands off your degree. Anyone can earn credit-by-exam regardless of age or education level.

To learn more, visit our Earning Credit Page

Transferring credit to the school of your choice

Not sure what college you want to attend yet? has thousands of articles about every imaginable degree, area of study and career path that can help you find the school that's right for you.

Create an account to start this course today
Try it risk-free for 30 days!
Create an account