What medications are given to a stroke patient in an Emergency Medical Services (EMS) setting?

Medications for Stroke Patients in Emergency Medical Services (EMS)

The primary medication administered to eligible stroke patients in the EMS setting is supplemental oxygen for hypoxemic patients (oxygen saturation <94%), while definitive reperfusion therapies like intravenous tissue plasminogen activator (tPA) are typically administered after hospital arrival. 1

Initial EMS Management

• Supplemental oxygen should be administered to hypoxemic stroke patients (oxygen saturation <94%) or those with unknown oxygen saturation 1
• EMS providers should establish IV access to prepare for potential hospital interventions 2
• Blood glucose should be checked in the field if possible, as hypoglycemia can mimic stroke symptoms 1
• For patients with persistent chest pain, intravenous morphine may be considered, though caution is advised in unstable angina/NSTEMI due to association with increased mortality 1

Blood Pressure Management in EMS

• Unless the patient is hypotensive (systolic blood pressure <90 mm Hg), prehospital intervention for blood pressure is not recommended 1
• Blood pressure management is typically reserved for the hospital setting, particularly before thrombolytic therapy 1

Hospital-Based Acute Stroke Medications

While not typically administered in the EMS setting, it's important to understand the medications that will be given upon hospital arrival:

Thrombolytic Therapy

• Intravenous alteplase (tPA) is the standard of care for eligible acute ischemic stroke patients within 4.5 hours of symptom onset 1
• The recommended dose is 0.9 mg/kg (maximum 90 mg) with 10% given as bolus over 1 minute and 90% as infusion over 60 minutes 1, 3
• Blood pressure must be <185/110 mmHg before tPA administration and maintained <180/105 mmHg for 24 hours after treatment 1

Antithrombotic Therapy

• For patients not receiving thrombolysis, early aspirin therapy is recommended 1, 4
• Aspirin is typically administered at a dose of 81-325 mg 5, 4

Critical Considerations for EMS

• Time is critical - EMS providers should rapidly identify stroke symptoms, establish time of symptom onset, and provide pre-arrival notification to the receiving hospital 1
• EMS should transport patients to the most appropriate stroke center when possible 1
• Stroke assessment scales should be used in the field to identify potential stroke patients 1
• Documentation of the last known normal time is essential for determining eligibility for time-sensitive interventions 1

Common Pitfalls to Avoid

• Delaying transport to administer medications in the field - rapid transport to a stroke center is the priority 1
• Failing to notify the receiving hospital of a potential stroke patient, which can delay in-hospital treatment 1
• Administering antihypertensive medications in the field without specific indications 1
• Missing the documentation of exact time of symptom onset or last known normal time 1

Remember that the primary role of EMS in stroke care is rapid identification, supportive care, and expedited transport to an appropriate facility where definitive treatments can be administered.