Synopsis
Deliver coordinated stroke-unit care that prevents aspiration, venous thrombosis, pressure injury and physiological deterioration while detecting cerebral oedema, haemorrhage and other early complications promptly.
- Admission to a specialist stroke unit improves outcomes through coordinated nursing, medical, therapy, nutrition and discharge care rather than through one isolated intervention.
- Screen swallowing with a validated process by a trained professional before oral food, fluid or medication; a patient who talks clearly can still aspirate silently.
- Give aspirin 300 mg after haemorrhage is excluded in acute ischaemic stroke, but wait at least 24 hours after thrombolysis and obtain the required follow-up imaging first.
Key red flags
Any new neurological deficit, fall in consciousness, severe headache or vomiting requires immediate senior stroke review and urgent repeat brain imaging.
Investigation priorities
Identify patients who need restriction of oral intake and formal swallowing assessment before food, fluid or medicines.
Management branches
A new stroke patient has not passed a trained swallowing screen or shows clinical dysphagia.
- Keep the patient nil by mouth, including routine tablets and water, while providing mouth care and an alternative safe route for essential hydration and medicines.
- Arrange prompt specialist swallowing assessment and communicate posture, texture and supervision recommendations to every staff member and carer.
The patient is medically and neurologically stable enough for active assessment and goal setting.
Key medicines
AspirinAfter haemorrhage is excluded, give 300 mg once daily by an appropriate safe route for acute ischaemic stroke; after thrombolysis wait 24 hours and obtain follow-up imaging first.
ParacetamolUse an adult oral, enteral or intravenous regimen within the product maximum when fever or pain requires treatment, accounting for body weight, frailty and liver disease.