Stroke

Get your attending!



Step 1: Obtain Last Known Well



* Stroke treatments including tPA and thrombectomy both require last known well* <3-4.5 hours for tPA* <24 hours mechanical thrombectomy



Step 2: Finger Stick Blood Glucose



* Hypoglycemia is classic mimic of CVA* Results can be obtained immediately



Step 3: STAT Head CT Without Contrast



* Poor sensitivity for ischemic stroke* Primary use is identification of hemorrhagic stroke* Required prior to administration of tPA!



Step 4: Perform NIHSS



* Use calculator (MDCalc)



Step 5: Give tPA (If No Contraindications)



* Follow department protocol and contraindications* Frequently being updated



Additional Reading



* tPA Basics (EM Clerkship)* 2013 AHA Stroke Guidelines (AHA)* NIH Stroke Scale/Score (MDCalc)