ACLS algorithm for suspected stroke

^[1]^[2]^[3]

Procedure

prehospital notification, a class 1 recommendation^[2]
general assessment < 10 minutes from arrival
- assess ABC's, vital signs
- oxygen by nasal cannula
  - supplemental oxygen in patients with normal SaO2 increases mortality^[3]
- obtain IV access
- laboratories: CBC, electrolytes, glucose, PT/PTT
- 12 lead EKG
- general neurologic screening
- alert stroke team, neurologist, radiologist, CT technician
neurologic examination < 25 minutes of presentation
- determine level of consciousness (Glasgow coma scale)
- determine level of stroke severity (NIH stroke scale)
- obtain non-contrast CT of head
goal is completion of above protocol with reading of CT scan in < 45 minutes
if hemorrhage, consult neurosurgery
- reverse any anticoagulation or bleeding disorder
- treat hypertension in awake patients
- see cerebral hemorrhage
if no hemorrhage
- evaluate for thrombolysis
  - door-to-treatment goal < 60 minutes
- lumbar puncture with CSF analysis if suspect subarachnoid hemorrhage despite negative CT
- see ischemic stroke
thrombolysis for ischemic stroke unless contraindicated
aspirin or clopidogrel 24 hours after thrombolysis^[3]

↑ ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
↑ ^2.0 ^2.1 Abdullah AR, Smith EE, Biddinger PD, Kalenderian D, Schwamm LH. Advance hospital notification by EMS in acute stroke is associated with shorter door-to-computed tomography time and increased likelihood of administration of tissue-plasminogen activator. Prehosp Emerg Care. 2008 Oct-Dec;12(4):426-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18924004
↑ ^3.0 ^3.1 ^3.2 Medical Knowledge Self Assessment Program (MKSAP) 14, 19. American College of Physicians, Philadelphia 2006, 2021