Adult Suspected Stroke

1 Patient presents with signs and

ACLS
certification institute
symptoms of possible stroke/CVA www.aclscertification.com
Initiate emergency response/EMS
system

2 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 NINDS Time Goals
stroke center
Obtain blood glucose reading (From ED Arrival)

10 min
3 Immediate Patient Assessment
10 min
and Stabilization
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

4 Immediate Assessment 25 min

by Stroke Team 25 min
Obtain/review patient history
Establish last normal (time of symptom onset)
Perform NIH Stroke Scale or
Canadian Neurological Scale exam

5 Does CT Scan
No Reveal Yes
Hemorrhage?

6 7 Consult neurosurgeon or
Possible ischemic stroke 45 min 45 min
neurologist
Consider fibrinolytic therapy
Perform fibrinolytic exclusions
Immediate transfer to appropriate
screening facility if neuroservices unavailable
Repeat neuro exam
(are symptoms improving to normal?)

8 Patient candidate
for No
fibrinolytic therapy?

10 Admit to neuro unit or

60 min

Yes 9 Administer Aspirin

appropriate ICU
If neurological condition worsens,
order stat repeat CT scan
NINDS Time Goal
(From Stroke Admission)

11 12
Review risk/benefits of fibrinolytic Initiate post-rtPA stroke pathway
3 hrs
60 min Continuous monitoring of BP per
therapy with patient/family
protocol and for any neurological
3 hrs
If acceptable, give rtPA
Withhold anticoagulants or antiplatelet changes/deterioration
treatment for 24 hrs Emergent admission to stroke/neuro unit
or appropriate ICU

ACLS Certification Institute Fast, Convenient and 100% Online ACLS Training and Certification
www.aclscertification.com | 1-800-448-2078 Earn Your ACLS in 1-2 Hours. Certify or Recertify Today!