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ACLS algorithm for suspected stroke
Procedure:
1) prehospital notification, a class 1 recommendation [2]
2) general assessment < 10 minutes from arrival
a) assess ABC's, vital signs
b) oxygen by nasal cannula
- supplemental oxygen in patients with normal SaO2 increases mortality [3]
c) obtain IV access
d) laboratories: CBC, electrolytes, glucose, PT/PTT
e) 12 lead EKG
f) general neurologic screening
g) alert stroke team, neurologist, radiologist, CT technician
3) neurologic examination < 25 minutes of presentation
a) determine level of consciousness (Glasgow coma scale)
b) determine level of stroke severity (NIH stroke scale)
c) obtain non-contrast CT of head
4) goal is completion of above protocol with reading of CT scan in < 45 minutes
5) if hemorrhage, consult neurosurgery
a) reverse any anticoagulation or bleeding disorder
b) treat hypertension in awake patients
c) see cerebral hemorrhage
6) if no hemorrhage
a) evaluate for thrombolysis
- door-to-treatment goal < 60 minutes
b) lumbar puncture with CSF analysis if suspect subarachnoid hemorrhage despite negative CT
c) see ischemic stroke
7) thrombolysis for ischemic stroke unless contraindicated
8) aspirin or clopidogrel 24 hours after thrombolysis [3]
Related
cardiopulmonary resuscitation (CPR)
stroke; cerebrovascular accident (CVA)
thrombolysis for ischemic stroke
General
algorithm
References
- ACLS - The Reference Texbook
ACLS: Principles & Practice, Cummins RO et al (eds),
American Heart Association, 2003 ISBN 0-87493-341-2
- Abdullah AR, Smith EE, Biddinger PD, Kalenderian D, Schwamm LH.
Advance hospital notification by EMS in acute stroke is
associated with shorter door-to-computed tomography time and
increased likelihood of administration of tissue-plasminogen
activator.
Prehosp Emerg Care. 2008 Oct-Dec;12(4):426-31.
PMID: 18924004
- Medical Knowledge Self Assessment Program (MKSAP) 14, 19.
American College of Physicians, Philadelphia 2006, 2021