Adult Suspected Stroke

ACLS

certification institute

Patient presents with signs and

symptoms of possible stroke/CVA
Initiate emergency response/EMS
system

www.aclscertification.com

Critical Assessments
and Actions
Assess and support ABCs, 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

Immediate Patient Assessment

and Stabilization

NINDS Time Goals

(From ED Arrival)

10 min
10 min

Assess ABCs, 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

Immediate Assessment
by Stroke Team

25 min

25 min

Obtain/review patient history

Establish last normal (time of symptom onset)
Perform NIH Stroke Scale or
Canadian Neurological Scale exam

No

Possible ischemic stroke

Does CT Scan
Reveal
Hemorrhage?

Yes

45 min

Consider fibrinolytic therapy

Perform fibrinolytic exclusions
screening
Repeat neuro exam
(are symptoms improving to normal?)

Consult neurosurgeon or
45 min
neurologist
Immediate transfer to appropriate
facility if neuroservices unavailable

8 Patient candidate

for
fibrinolytic therapy?

Yes

No

10

Administer Aspirin

Admit to neuro unit or

60 min
appropriate ICU
If neurological condition worsens,
order stat repeat CT scan

NINDS Time Goal

(From Stroke Admission)

11

Review risk/benefits of fibrinolytic

60 min
therapy with patient/family
If acceptable, give rtPA
Withhold anticoagulants or antiplatelet
treatment for 24 hrs

ACLS Certification Institute

www.aclscertification.com | 1-800-448-2078

12

Initiate post-rtPA stroke pathway

3 hrs
Continuous monitoring of BP per
protocol and for any neurological
changes/deterioration
Emergent admission to stroke/neuro unit
or appropriate ICU

3 hrs

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