- Begin stroke pathway.
- Continue to support airway, breathing, and circulation.
- Maintain oxygen saturation 94%–99%.
- Cardiac monitoring for first 24 hours or longer, if indicated.
- Avoid intravenous D5W or excessive fluid loading.
- Monitor blood pressure.
- Manage hypertension if systolic blood pressure is greater than 220 mm Hg or diastolic blood pressure is greater than 120 mm Hg.
- Monitor blood glucose.
- Treat hyperglycemia.
- Monitor temperature.
- Treat fever with acetaminophen.
- Perform dysphagia screening/swallow evaluation.
- Monitor for complications of stroke and fibrinolytic therapy (if administered).
Cincinnati Prehospital Stroke Scale
- Facial droop: Have patient show teeth or smile.
- Normal-Both sides of face move equally well.
- Abnormal-One side of face does not move as well as the other side.
- Arm drift: Have patient close eyes and hold both arms straight out with palms up for 10 sec.
- Normal-Both arms move the same or do not move at all.
- Abnormal-One arm does not move or drifts down lower than the other.
- Speech: Have the patient say “You can’t teach an old dog new tricks.”
- Normal-Patient uses correct words with no slurring.
- Abnormal-Patient slurs words, uses inappropriate words, or is unable to speak.
Note: The presence of a single abnormality has a sensitivity of 59% and a specificity of 89% when scored by prehospital providers.
| Observation | Response | Score |
|---|---|---|
| Eye response |
| 4 |
| 3 | |
| 2 | |
| 1 | |
| Best verbal response |
| 5 |
| 4 | |
| 3 | |
| 2 | |
| 1 | |
| Best motor response |
| 6 |
| 5 | |
| 4 | |
| 3 | |
| 2 | |
| 1 | |
| Total score | Normal | 15 |
Score can range from 3 (lowest neurological function) to 15 (highest function).
Score 14–15: Mild dysfunction
Score 11–13: Moderate to severe dysfunction
Score 
10: Severe dysfunction