Neurologic
■ Stroke
EMS Assessment and Treatment
■ Support ABCs, give O2, check glucose level
■ Perform stroke assessment (see LAPSS or CPSS, after Stroke)
■ Establish onset of symptoms
■ Rapid transport to stroke center (bring family member)
■ Alert hospital: “possible stroke patient”
Immediate Assessment and Stabilization
■ Check ABCs, vital signs; give O2 if hypoxemic
■ Start IV fluids; get blood samples; 12-lead ECG
■ Check blood glucose level: correct
hypoglycemia/hyperglycemia 00:10
■ Perform general neurologic screening 10 mins
assessment
Max time: 10 minutes
■ Activate stroke team
■ Initiate emergency CT scan or MRI of brain
Immediate Neurologic Assessment by Stroke Team
■ Review patient history
■ Establish onset of symptoms
■ Perform neurologic examination (NIH Stroke
00:25
Scale or Canadian Neurologic Scale) 25 mins
Max time: 15 minutes
Neuro
, Neurologic Neurologic Neuro Neurologic Neurologic
54
Hemorrhage on CT/MRI?
NO Hemorrhage: Hemorrhage
Probable 20 minutes
Ischemic Stroke for rtPA
00:45 decision
45 mins
■ Review fibrinolytic exclusions:
are any present?
■ Repeat neurologic examination:
deficits improving?(If so, give
aspirin and begin Stroke Pathway.)
Patient remains candidate for fibrinolytic therapy?
Review risks and benefits with patient and family.
If acceptable:
Administer rtPA if <3–4.5* hours from documented
onset of symptom. (*<3 hours if any: >80 years old,
severe stroke, NIHSS score >25, taking oral antico-
agulant, Hx of diabetes, and prior ischemic stroke)
Do not give anticoagulants or antiplatelets for 24 hours.
Begin Stroke Pathway
Hemorrhage Present on CT/MRI
■ A bleeding patient is never a candidate for rtPA.
■ Consult neurologist or neurosurgeon.
■ Consider transfer if neurology consult unavailable.
01:00
■ *Begin Stroke or Hemorrhage Pathway 1 hour
■ Admit to stroke unit or ICU.
Max time: 15 minutes
■ Monitor BP: treat if indicated.
■ Monitor blood glucose level and treat, if needed.
■ Initiate supportive therapy and treat
comorbidities. 03:00
3 hours
■ Monitor neurologic status: perform
emergency CT if patient deteriorates. Max time: 2 hours
■ Stroke
EMS Assessment and Treatment
■ Support ABCs, give O2, check glucose level
■ Perform stroke assessment (see LAPSS or CPSS, after Stroke)
■ Establish onset of symptoms
■ Rapid transport to stroke center (bring family member)
■ Alert hospital: “possible stroke patient”
Immediate Assessment and Stabilization
■ Check ABCs, vital signs; give O2 if hypoxemic
■ Start IV fluids; get blood samples; 12-lead ECG
■ Check blood glucose level: correct
hypoglycemia/hyperglycemia 00:10
■ Perform general neurologic screening 10 mins
assessment
Max time: 10 minutes
■ Activate stroke team
■ Initiate emergency CT scan or MRI of brain
Immediate Neurologic Assessment by Stroke Team
■ Review patient history
■ Establish onset of symptoms
■ Perform neurologic examination (NIH Stroke
00:25
Scale or Canadian Neurologic Scale) 25 mins
Max time: 15 minutes
Neuro
, Neurologic Neurologic Neuro Neurologic Neurologic
54
Hemorrhage on CT/MRI?
NO Hemorrhage: Hemorrhage
Probable 20 minutes
Ischemic Stroke for rtPA
00:45 decision
45 mins
■ Review fibrinolytic exclusions:
are any present?
■ Repeat neurologic examination:
deficits improving?(If so, give
aspirin and begin Stroke Pathway.)
Patient remains candidate for fibrinolytic therapy?
Review risks and benefits with patient and family.
If acceptable:
Administer rtPA if <3–4.5* hours from documented
onset of symptom. (*<3 hours if any: >80 years old,
severe stroke, NIHSS score >25, taking oral antico-
agulant, Hx of diabetes, and prior ischemic stroke)
Do not give anticoagulants or antiplatelets for 24 hours.
Begin Stroke Pathway
Hemorrhage Present on CT/MRI
■ A bleeding patient is never a candidate for rtPA.
■ Consult neurologist or neurosurgeon.
■ Consider transfer if neurology consult unavailable.
01:00
■ *Begin Stroke or Hemorrhage Pathway 1 hour
■ Admit to stroke unit or ICU.
Max time: 15 minutes
■ Monitor BP: treat if indicated.
■ Monitor blood glucose level and treat, if needed.
■ Initiate supportive therapy and treat
comorbidities. 03:00
3 hours
■ Monitor neurologic status: perform
emergency CT if patient deteriorates. Max time: 2 hours
