Possibility for stroke
1) Confusion, decreased LOC (Level of consciousness).
2) Cincinnati Prehospital Stroke Scale:
1 of the following suggests possibility for stroke:
a) Facial droop (‘smile’)
b) Arm drift (‘raise both arms with your eyes CLOSED’)
c) Speech (slurred, mute, inappropriate words, dysarthria).
3) Symptoms NOT improving spontaneously (differential diagnosis
with TIA transit ischemic attack).
The above criteria are also criteria for fibrinolytic therapy (alteplase
Intracranial hemorrhage ruled out with head CT.
ABCDs. Give oxygen. Initiate IV line of normal saline NS. Perform
ECG. Transport/ transfer patient for definite care (stroke unit).
Perform a non contrast CT. Don’t give any drug before the CT.
CT initially may not show ischemic stroke.
On Lab tests don’t forget to ask for glucose and also coagulation
studies. However, do as soon as possible a glucose finger stick
test to exclude hypoglycemia which may mimic stroke.
Don’t give D5W (5%dextrose) on stroke! Give normal saline NS.
The goal time for fibrinodolysis is < 3 h from symptoms onset and
< 60min from ER – ED (emergency room/ department) arrival (door
to treatment time).
Fibrinolytic therapy has as complication about 6% brain
Do not decrease the BP fast. Call Expert.
Correct glucose if high or low (with symptoms).
Treat cardiac dysrhythmias if unstable, but don’t treat immediately
AF (atrial fibrillation). Call an expert.
Check CI (contraindications) for thrombolysis e.g. a SBP > 185 or
a DBP> 110 are CI.