Kamalnayan Bajaj Hospital Emergency Protocol

Clinical Assessment of Potential Stroke Patient

CMO on Duty Nurse on Duty

Clinical Examination To do List

NBM except medications
Record Time of Onset of Symptoms
NO Foleys, RT, arterial or venous line
<4 hrs/ >4 hrs/ Unknown
2 Large Bore IV lines to be placed
Wake up Stroke Y/N
Elevate Head End
Record BP O2 supplement if O2 saturation<94%
NIHSS IV Dextrose 5% 100 ml if BSL< 60
Random BSL

Contraindication Checklist Activate Stroke Code

Known bleeding disorder Pharmacy - Actilyse
GI bleed during last 3 months CT/MRI - availability
Major surgery or trauma < 3 mo Clinical laboratory
Recent obstetric delivery < 10 days ICU in charge
Patient on warfarin INR>1.7 Neurologist
Liver disease with portal HTN Neurosurgeon
Prior stroke within 3 months Nursing in charge
Recent Major Surgery within past 2 wk Registration Desk Transport facility

Stroke Protocol Lab Work to Include

CBC
PT INR
Imaging CREATININE & ELECTROLYTES
LFT
HIV & HBSAG

If Onset < 4 Hrs If >4 HOURS or time of

onset unknown / in sleep

Investigation of Choice Investigation of Choice

CT Brain Plain MRI BRAIN WITH ANGIO

Inform Consultant if Bleed present.

Investigation to Include
If absent, Look for dense MCA sign
T1 axial, FLAIR axial, DWI/ADC, SOS
Look for dense Basilar sign
Gradient & Brain angio
Hypodensity

Obtain Consent for thrombolysis

GIVE BOLUS OF Alteplase injection
and shift patient for MRA/CTA If watershed infarct present, then
LARGE ARTERY OCCLUSION: perform - neck angio
DISCUSS With relatives about role of
intervention and inform Cath Lab