Diagnosis and Initial Treatment of Ischemic Stroke. Stroke Code Algorithm.

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and initial treatment of ischemic stroke. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 June. 57 p. Diagnosis and Initial Treatment of Ischemic Stroke Stroke Code Algorithm Admit and begin stroke code. A Hospitals should consider developing and implementing critical pathways, standing orders and a stroke code process to accomplish this rapid evaluation and treatment. Evaluation (should occur concurrently with intervention). *Review history and tPA treatment indications and contraindications and baseline NIHSS. *Perform exam with neuro checks (not NIHSS) and vital signs every 15 minutes. *Record weight (estimate if needed). *Draw blood for lab tests. *Perform EKG. *Perform CT head without contrast. *Other cardiac assessment as appropriate (telemetry). *Consider if intra-arterial thrombolytic candidate. A Intervention (should occur concurrently with evaluation). *Educate patient / family. *Treat blood pressure (BP) if greater than 185 systolic or 110 diastolic. *Initiate two IV lines. *Start IV fluids. *Treat hyperthermia. *Treat hypo- or hyperglycemia. *Treat hypoxia. *Treat hypotension. A Patient meets criteria for tPA, has no contraindications and symptom onset still less than 3 hours? Document reason Initiate tPA Initiate aspirin unless contraindicated. A Post-ED medical management (postthrombolysis). *Admit to ICU or acute stroke care unit / cardiac monitoring, *Perform vital signs with neuro checks (not NIHSS). *Treat BP if greater than 180 systolic or 105 diastolic. *Initiate bleeding precautions. *Monitor for CNS hemorrhage. *Initiate antithrombotic therapy 24 hours after tPA. A Post-ED medical management (not a thrombolysis candidate). *Admit to ICU or acute stroke care unit / cardiac monitoring. *Perform vital signs with neuro checks (not NIHSS). *Treat BP if greater than 220 systolic or 120 diastolic or mean arterial pressure (MAP) greater than 130. *Continue antithrombotic therapy. A Other post-ED medical management (first 24-48 hours). *Continue to treat hyperthermia or hyperglycemia. *Continue IV fluids. *Initiate deep vein thrombosis (DVT) prophylaxis. *Perform swallow evaluation. *Initiate early rehabilitation therapy post-ED medical management (first 24-48 hours). *Perform nutritional status assessment. A A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.