In stroke protocol activation, what is a critical step to ensure patient safety before imaging?

• A. Obtain consent.
• B. Place patient in Trendelenburg position.
• C. Maintain a strict NPO status until imaging.
• D. Secure airway and monitor oxygenation.

Answer: (D)

In acute stroke care, the first priority before imaging is to secure the airway and ensure adequate oxygenation. The brain is highly sensitive to low oxygen levels, and hypoxemia can worsen ischemic injury, increasing the amount of brain tissue that is damaged. By confirming the airway is open and protected (and advancing to airway support if the patient cannot maintain it) and by continuously monitoring oxygen saturation with supplemental oxygen as needed, you minimize the risk of hypoxia while awaiting imaging. This stabilizes the patient quickly, which is crucial since imaging (often a non-contrast CT) is performed urgently to guide treatment decisions. While obtaining consent is important in many situations, emergent stroke imaging is typically pursued without delay for consent. Placing the patient in Trendelenburg is not advised because it can compromise breathing and cerebral perfusion. Requiring strict NPO status before imaging isn’t necessary for CT imaging.