Acute Stroke Protocol (BI 2005)
Acute stroke patients with known time of onset < 3 hours for tPA and < 6 hours
for experimental treatment
Clinical presentation: aphasia, ataxia, diplopia, dysarthria, facial weakness,
visual loss, hemiparesis, quadriparesis, hemisensory loss
Call a Stroke Code and state Stroke Code and give location of patient…this activates
the Stroke Code Team
- Order a “Stroke Protocol” STAT head CT w/o contrast
- Draw blood for SMA-7, CBC with platelets,
PT/INR/PTTT, T&S
- Check finger stick glucose should be > 50 but <
400
- Check blood pressure: should be < 185 systolic and
< 110 diastolic before giving tPA
- Perform NIHSS (see reverse)
- Review history for possible contraindications for thrombolysis
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Contraindications for thrombolysis (tPA):
- Stroke onset > 3 hours
- Rapidly improving or minor symptoms
- Seizure at onset
- FSG < 50 or > 400
- Inability to easily lower SBP < 185 or DBP <
110
- Suspicion of Subarachnoid Hemorrhage
- Intracerebral hemorrhage on CT
- H/o intracranial neoplasm, AVM, or aneurysm
- Any prior history of intracranial hemorrhage
- Head trauma, intracranial or spinal surgery or stroke
within 3 months
- Major surgery within 2 weeks
- GI or GU hemorrhage < 21 days
- Noncompressible arterial puncture < 7 days
- Warfarin use with INR > 1.7 or PT > 15 secs
- Heparin use < 48 hours with elevated PTT
- Platelets < 100,000
For tPA CONTROL BP: goal < 185 systolic and < 110 diastolic
Rx: Suggest 10-20 mg IV Labetaolol over 1-2 minutes and may repeat x1
TIME IS BRAIN: Rx earlier is better for BEST outcome
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