Free handy references about Adult Suspected Stroke Algorithm from the ACLS Certification Institute. View all ACLS algorithms at http://www.ACLScertification.com/

1. 2 Critical Assessments
and Actions
4 Immediate Assessment
by Stroke Team
5 Does CT Scan
10 min
25 min
No Reveal
Yes
Hemorrhage?
6 Possible ischemic stroke
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Adult Suspected Stroke
Yes 9
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NINDS Time Goal
(From Stroke Admission)
3 hrs
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Immediate Patient Assessment
and Stabilization
3
1 Patient presents with signs and
symptoms of possible stroke/CVA
Initiate emergency response/EMS
system
Assess and support ABC’s, supply oxygen
if needed
Initiate pre-hospital stroke assessment
Establish last normal (time of symptom onset)
Alert and transport patient to appropriate
stroke center
Obtain blood glucose reading
Assess ABC’s, vital signs
Initiate appropriate oxygen therapy if hypoxic
Establish vascular access, send blood for appropriate
lab testing
Assess for and treat hypoglycemia
Perform stroke screening assessment
Activate stroke team
Order stat CT scan or MRI of brain
Perform 12-Lead ECG
Obtain/review patient history
Establish last normal (time of symptom onset)
Perform NIH Stroke Scale or
Canadian Neurological Scale exam
Consider fibrinolytic therapy
Perform fibrinolytic exclusions
screening
Repeat neuro exam
(are symptoms improving to normal?)
7 Consult neurosurgeon or
neurologist
Immediate transfer to appropriate
facility if neuroservices unavailable
8 Patient candidate
for
fibrinolytic therapy?
No
Administer Aspirin
Review risk/benefits of fibrinolytic
therapy with patient/family
If acceptable, give rtPA
Withhold anticoagulants or antiplatelet
treatment for 24 hrs
Admit to neuro unit or
appropriate ICU
If neurological condition worsens,
order stat repeat CT scan
11
10
12 Initiate post-rtPA stroke pathway
Continuous monitoring of BP per
protocol and for any neurological
changes/deterioration
Emergent admission to stroke/neuro unit
or appropriate ICU
NINDS Time Goals
(From ED Arrival)
10 min
25 min
45 min 45 min
60 min
60 min 3 hrs