158: What’s Changed in Acute Stroke Care? New AHA Stroke Guidelines with Dr. Prabahkaran

The stroke guidelines just changed and it’s exciting and nuanced! What you do in the first 30 minutes could drastically change your patient's outcome. In this episode, Dr. Shyam Prabhakaran, neurologist and chief writer of the new 2026 AHA Stroke Guidelines, explains what's changed and how these guidelines are changing practice at the bedside.

Stroke treatment decisions are getting faster, more nuanced, and more imaging-driven. Inclusion/exclusion criteria and whether to give thrombolytics, who is a candidate for thrombectomy, and when to touch the blood pressure have all been updated. Know the updates before your next stroke alert!

Topics discussed in this episode:

1. Introducing the classic extended window patient case
2. Thrombolytics vs. thrombectomy explained
3. EMS destination decision: Choosing primary vs. comprehensive stroke center
4. How reperfusion time windows have changed
5. Advanced imaging: ASPECTS and thrombectomy eligibility
6. Treatment options for patients presenting outside of the 4.5 hr window
7. Blood pressure management recommendations
8. What nurses should do in the first 15-30 minutes
9. LVO red flags at the bedside
10. Pediatric ischemic stroke

Check out the new AHA Stroke Guidelines:

https://newsroom.heart.org/news/new-guideline-expands-stroke-treatment-for-adults-offers-first-pediatric-stroke-guidance

Mentioned in this episode:

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