A patient with suspected stroke last seen well within 4 hours. What is the immediate action?

• A. Activate the stroke protocol; ensure airway and call for CT imaging; prepare for potential thrombolysis per protocol.
• B. Activate the cardiac protocol; call for MRI.
• C. Begin anticoagulation before imaging.
• D. Wait for lab results before taking action.

Answer: (A)

In suspected acute stroke within the treatment window, the priority is to move quickly to imaging and possible reperfusion therapy. The immediate action is to activate the stroke protocol, ensure airway and overall stabilization, and rapidly obtain imaging to guide treatment. Non-contrast CT of the head should be performed as soon as possible to distinguish an ischemic stroke from a hemorrhagic one. This distinction is crucial because thrombolytic therapy is only appropriate for ischemic stroke and cannot be given safely if a bleed is present. By preparing for thrombolysis per protocol, you set up the patient for potentially life-saving reperfusion if imaging shows eligibility and there are no contraindications. Initiating anticoagulation before imaging is avoided because it could worsen a hemorrhage, MRI is not the fastest initial step in the ED, and waiting for lab results would delay critical treatment.