This section is limited to Adult patients.

First 10 minutes

• ABC's
• O₂, Monitor, IV
• EKG
• Draw labs, accucheck, determine other causes (hypoglycemia, drugs, trauma, EtOH)
• Neuro exam
• Stroke team activation
• Order Stat Head CT

First 25 minutes (includes items above)

• Establish onset of symptoms (<3 hrs onset to time of w/u completion needed to give rTPA)
• Physical Assessment, NIH stroke scale
• Contraindications reviewed
• Head CT with radiologist read within 45 minutes of arrival

At 45 minutes: CT should be read

If fibrinolytics are given, goal is at or before 60 minutes from arrival in ED.

Option #1: CT Head shows no hemorrhage

• Consider fibrinolytic therapy
• Formally review fibrinolytic exclusions
• Repeat Neurologic examination; if deficits are rapidly improving do not give rTPA.
• Review risks and benefits with patient/family and obtain consent if appropriate
• Confirm at time of administration of rTPA that no contraindications are present, rapid improvement is not occurring spontaneously, consent obtained and appropriate consultations obtained.
• If patient is not a candidate for fibrinolytics, administer Asprin

Option #2: CT Head shows hemorrhage

• Consult Neurology/Neurosurgery

All Patients

• Admit under stroke pathway to stroke unit if available
• Monitor and treat BP (if indicated)
• Carefully monitor neurologic status; obtain emergent CT for any deterioration
• Monitor blood glucose (treat if needed)
• Supportive therapy and treat other underlying conditions

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.