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Suspected Stroke Algorithm: NINDS Time Goals

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816 views1 page

Suspected Stroke Algorithm: NINDS Time Goals

Uploaded by

johndoe1995
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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SUSPECTED STROKE ALGORITHM

Activate Emergency Response (EMS)


Identify signs and symptoms of possible stroke

1 SUPPORT ABC’s 4 TRIAGE TO STROKE CENTER


CRITICAL EMS Give oxygen if needed
5 ALERT HOSPITAL
ASSESSMENTS 2 PREHOSPITAL STROKE ASSESSMENT Consider direct transfer to CT scan
AND ACTIONS 3 ESTABLISH TIME OF SYMPTOM ONSET 6 CHECK GLUCOSE IF POSSIBLE
When they were last normal
NINDS Time Goals
ED Arrival
IMMEDIATE ASSESS ABC’S, VITAL SIGNS NEUROLIGIC SCREENING ASSESSMENT
GENERAL PROVIDE OXYGEN IF HYPOXEMIC ACTIVATE STROKE TEAM
ASSESSMENT ORDER EMERGENT CT SCAN OR MRI OF BRAIN
IV ACCESS AND LAB ASSESSMENTS
AND
CHECK GLUCOSE; TREAT IF INDICATED OBTAIN 12-LEAD ECG
STABILIZATION

ED Arrival
IMMEDIATE REVIEW PATIENT HISTORY
NEUROLOGIC ESTABLISH TIME OF SYMPTOM ONSET
ASSESSMENT BY OR LAST KNOWN NORMAL
STROKE TEAM PERFORM NEUROLOGIC EXAMINATION
NIH Stroke Scale or Canadian Neurological Scale
OR DESIGNEE
ED Arrival

No Hemorrhage Hemorrhage
Hemorrhage shown by CT Scan?

Probable acute ischemic stroke


Consider fibrinolytic therapy Is patient a candidate for fibrinolytic therapy?
Check for fibrinolytic exclusions and repeat
neurologic exam YES NO

ED Arrival ASK: Are deficits rapidly improving to normal?

Review risks and benefits with Administer Aspirin


patient and family
If acceptable
Give rtPA
Not anticoagulants or antiplatelet Consultation
treatment for 24 hours
ED Arrival Consult neurologist or neurosurgeon and
3 HOURS
consider transfer if not available

Begin post-rtPA stroke pathway


Aggressively monitor:
BP per protocol Begin stroke or hemorrhage pathway
For neurologic deterioration
Emergent admission to stroke unit Admit to stroke or intensive care unit
or intensive care unit

This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.

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