Stroke Algorithm Flashcards
Time frame of initial stroke steps
- Immediate general assessment with 10 minutes
- Neuro assessment and CT scan within 25 minutes of arrival at hospital
- Interp of CT within 45 minutes
- Admin of fibrinolytic within 1st hour of hospital and 3 hours from onset of symptoms
Stroke algorithm step 1
Identify signs and symptoms of possible stroke
Active emergency response
Stroke algorithm step 2, EMS
EMS assessment of actions
- Support ABC’s and O2 if necessary
- Pre hospital stroke assessment
- Establish time of onset of symptoms
- Triage to stroke center
- Alert hospital
- Check glucose if possible
Stroke algorithm step 3
Immediate general assessment and stabilization
- Assess ABCs, vitals
- Provide O2 if hypoxemic
- Obtain IV access (blood count, coag, glucose)
- Check glucose, treat if indicated
- Perform neuro screening
- Activate stroke team
- Order CT
- Obtain ECG
Stroke algorithm step 4
After assessment and stabilization
Neuro assessment:
- Review patient history
- Establish time of symptom onset
- Perform neuro exam
Stroke algorithm step 5
After neuro assessment:
Does CT show hemorrhage?
If CT scan shows no hemorrhage (Step 6 Left side)
Probable ischemic stroke
- Check for fibrinolysis exclusions
- Repeat neuro exam, are deficits rapidly improving to normal?
If CT show hemorrhage (Step 6 right side)
Consult neurologist or neurosurgeon
Stroke algorithm: if not candidate for fibrinolytics?
Administer aspirin
Stroke algorithm: if candidate for fibrinolytics
- Review risks with family
- Give rtPA
- No anticoagulants or anti-platelets for next 24 hours
After giving rtPA for stroke?
Begin post rtPA pathway
- aggressively monitor
Signs of stroke
Sudden:
- Weakness or numbness of face, arm, leg, especially on one side of the body
- Confusion
- Trouble speaking or understanding
- Trouble seeing out of one or both eyes.
- Sudden trouble walking
- Dizziness
- Severe HA
Cincinnati prehospital stroke scale
- Facial droop
- Arm drift
- Abnormal speech
rtPA exclusion criteria
- Significant head trauma or prior stroke last 3 months
- S/sx suggesting subarachnoid hemorrhage
- Arterial puncture at non-compressable site in last 7 days
- Hx of previous intracranial hemorrhage
- Elevated BP SBP>185 or DBP>110
- Active internal bleeding
- Bleeding diathesis
- Blood glucose concentration
Bleeding diathesis (exclusion criteria for rtPA)
- Platelet count upper limit of normal
- Current use of antiCoag with INR > 1.7 or PT >15
- Current use of direct thrombin inhibitors
- Blood glucose concentration
Time window for using rtPA for stroke?
FDA: by 3 hours from symptom onset
AHA: advise up to 4.5 hours from symptom onset
Treating hypertension when considering rtPA treatment
BP cutoff: > 185/110
- Labetalol 10-20 mg IV over 1-2 minutes, may repeat 1x
- Nicardipine IV 5 mg/h, titrate up by 2.5 mg/h, every 5-15 minutes, max 15 mg/hr
8 D’s of stroke care
Detection Dispatch Delivery Door Data Decision Drug/device Disposition
Time frame of initial stroke steps
General assessment with in 10 minutes
Neuro assessment and CT scan within 25 minutes
Interpretation of CT scan within 45 mintues
rtPA within 1 hour in hospital and 3 hours from onset of symptoms
