2
Hemisphere IV-Rapid Stroke response Exam with verified detailed || || || || || || || ||
answers
EMS goal on scene || || ||
15 minutes
||
Oxygen saturation in stroke || || ||
>94%
Onset of symptoms to thrombolytics time
|| || || || ||
4.5 hours
||
Onset of symptoms to thrombectomy time
|| || || || ||
24 hours
||
Stroke Center designations || ||
Comprehensive Stroke Center (CSC) || || ||
Thrombectomy-capable stroke center (TSC) || || ||
Primary Stroke Center (PSC) || || ||
Acute Stroke Ready Hospital (ASRH)
|| || || ||
Door to door transfer time
|| || || ||
<= 60 min hospital to hospital transfer
|| || || || || ||
associated symptoms of stroke || || ||
*especially with cerebellar and hemorrhagic stroke || || || || ||
vomiting, nausea ||
SBP >220 ||
stiff neck ||
Photophobia
Coma and decreased level of consciousness
|| || || || ||
Overlooked symptoms of stroke || || ||
dizziness
headache
general weakness or fatigue || || ||
, 2
nausea, vomiting ||
disorientation, confusion, or memory problems || || || ||
Door to doctor time
|| || ||
ASAP - 10 min || || ||
BP parameters
||
do not treat elevated BP unless concurrent myocardial infarction, heart failure, aortic
|| || || || || || || || || || || ||
dissection, or confirmed hemorrhagic stroke || || || ||
Door to stroke team time (neuro expertise)
|| || || || || ||
ASAP - 15 || ||
Prior to thrombolytic
|| ||
Noncontract CT or MRI to exclude hemorrhage || || || || || ||
Blood glucose level - to rule out hypoglycemia
|| || || || || || ||
BP under 180/105
|| ||
When to repeat CT in Hosp to hosp transfers
|| || || || || || || ||
>60 minutes since last CT
|| || || ||
Baseline labs ||
CBC, electrolytes, Renal function creatinine, troponin and ecg to evaluate MI and
|| || || || || || || || || || || ||
arrhythmias
Coag studies if on anticoagulants
|| || || ||
Advanced imaging if considering mechanical thrombectomy || || || || ||
Airway management ||
Swallow screen should be performed on all stroke patients
|| || || || || || || ||
npo until complete
|| ||
How long is BP elevated after stroke
|| || || || || ||
24-48 hrs ||
Increased cardiac risk with stroke || || || ||
Arrhythmias (including A-fib) observed in about 25% of patients within 72 hrs of stroke|| || || || || || || || || || || || ||
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
|| || || || || || || || || ||
Hemisphere IV-Rapid Stroke response Exam with verified detailed || || || || || || || ||
answers
EMS goal on scene || || ||
15 minutes
||
Oxygen saturation in stroke || || ||
>94%
Onset of symptoms to thrombolytics time
|| || || || ||
4.5 hours
||
Onset of symptoms to thrombectomy time
|| || || || ||
24 hours
||
Stroke Center designations || ||
Comprehensive Stroke Center (CSC) || || ||
Thrombectomy-capable stroke center (TSC) || || ||
Primary Stroke Center (PSC) || || ||
Acute Stroke Ready Hospital (ASRH)
|| || || ||
Door to door transfer time
|| || || ||
<= 60 min hospital to hospital transfer
|| || || || || ||
associated symptoms of stroke || || ||
*especially with cerebellar and hemorrhagic stroke || || || || ||
vomiting, nausea ||
SBP >220 ||
stiff neck ||
Photophobia
Coma and decreased level of consciousness
|| || || || ||
Overlooked symptoms of stroke || || ||
dizziness
headache
general weakness or fatigue || || ||
, 2
nausea, vomiting ||
disorientation, confusion, or memory problems || || || ||
Door to doctor time
|| || ||
ASAP - 10 min || || ||
BP parameters
||
do not treat elevated BP unless concurrent myocardial infarction, heart failure, aortic
|| || || || || || || || || || || ||
dissection, or confirmed hemorrhagic stroke || || || ||
Door to stroke team time (neuro expertise)
|| || || || || ||
ASAP - 15 || ||
Prior to thrombolytic
|| ||
Noncontract CT or MRI to exclude hemorrhage || || || || || ||
Blood glucose level - to rule out hypoglycemia
|| || || || || || ||
BP under 180/105
|| ||
When to repeat CT in Hosp to hosp transfers
|| || || || || || || ||
>60 minutes since last CT
|| || || ||
Baseline labs ||
CBC, electrolytes, Renal function creatinine, troponin and ecg to evaluate MI and
|| || || || || || || || || || || ||
arrhythmias
Coag studies if on anticoagulants
|| || || ||
Advanced imaging if considering mechanical thrombectomy || || || || ||
Airway management ||
Swallow screen should be performed on all stroke patients
|| || || || || || || ||
npo until complete
|| ||
How long is BP elevated after stroke
|| || || || || ||
24-48 hrs ||
Increased cardiac risk with stroke || || || ||
Arrhythmias (including A-fib) observed in about 25% of patients within 72 hrs of stroke|| || || || || || || || || || || || ||
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
|| || || || || || || || || ||
