Initial Treatment for Suspected Cerebrovascular Accident (CVA) in Primary Care Setting

Immediate Assessment and Stabilization

The American Heart Association recommends performing rapid evaluation of airway, breathing, and circulation to ensure basic physiological stability in patients with suspected cerebrovascular accident 1, 2
The American College of Cardiology suggests providing supplemental oxygen to maintain oxygen saturation ≥94% in patients with suspected cerebrovascular accident 3, 4
The American Heart Association advises correcting hypotension and hypovolemia to maintain systemic perfusion levels necessary to support organ function in patients with suspected cerebrovascular accident 3, 4
The Endocrine Society recommends checking capillary blood glucose immediately and treating hypoglycemia (glucose below a certain threshold) with IV dextrose in patients with suspected cerebrovascular accident 3, 4
The American Stroke Association recommends using a validated stroke screening tool to confirm suspicion of stroke in patients with suspected cerebrovascular accident 3, 4

The American College of Emergency Physicians suggests arranging immediate transfer to a hospital with stroke capabilities without delaying transfer for extensive testing in the primary care setting in patients with suspected cerebrovascular accident 3, 4
The National Institute of Neurological Disorders and Stroke recommends performing a standardized stroke severity assessment using a scale such as the National Institutes of Health Stroke Scale (NIHSS) if available in the primary care setting 3, 4
The American Heart Association advises that basic laboratory tests can be initiated if they don't delay transfer: complete blood count, electrolytes, coagulation studies, and blood glucose in patients with suspected cerebrovascular accident 3, 4
The American College of Cardiology suggests that ECG should be performed if available and won't delay transfer to identify atrial fibrillation or other cardiac arrhythmias in patients with suspected cerebrovascular accident 3, 4

The American Heart Association recommends that emergency treatment of hypertension is indicated only if there is concomitant acute myocardial ischemia, aortic dissection, or preeclampsia/eclampsia in patients with suspected cerebrovascular accident 3, 4
The American College of Cardiology advises avoiding aggressive blood pressure lowering in the primary care setting unless BP exceeds a certain threshold in patients with suspected ischemic stroke who may be candidates for thrombolytic therapy 3, 4
The American Stroke Association suggests considering acute lowering of systolic BP to a target of 140 mmHg in patients with suspected intracerebral hemorrhage and hypertension presenting within 6 hours of symptom onset 1

The American Heart Association recommends discontinuing anticoagulation immediately in patients taking anticoagulants with suspected intracerebral hemorrhage 1
The American College of Emergency Physicians advises preparing for potential tracheal intubation during transfer in patients with compromised airway or insufficient ventilation due to impaired alertness or bulbar dysfunction 3, 4
The American Academy of Neurology suggests treating seizures occurring at the time of stroke onset with appropriate short-acting medications if they are not self-limited 2

The American College of Emergency Physicians recommends contacting the receiving hospital's stroke team to provide pre-arrival notification in patients with suspected cerebrovascular accident 2
The American Heart Association advises providing essential information to the receiving facility: time of symptom onset/last known well, current medications, and changes in condition since symptom onset in patients with suspected cerebrovascular accident 2
The American Telemedicine Association suggests considering telemedicine/telestroke consultation if available to guide management before and during transfer in patients with suspected cerebrovascular accident 3, 4

The American College of Emergency Physicians recommends avoiding delaying transfer to hospital for extensive diagnostic workup in the primary care setting in patients with suspected cerebrovascular accident 3, 4
The American Heart Association advises against administering aspirin or other antithrombotic agents before brain imaging rules out hemorrhagic stroke in patients with suspected cerebrovascular accident 1
The American College of Cardiology suggests avoiding aggressively lowering blood pressure in suspected ischemic stroke patients 3, 4