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)