7/29/2019 CEM6195 Stroke
1/1
Stroke
Definition: an acute loss of focal or global neurological or
ocular function lasting more than 24 hours, with no obvious
non-vascular causeStroke mimics include: migraine, epilepsy,
post-ictal paralysis, hypoglycaemia and metabolic disturbances,
pscyhological problems, cognitiveimpairment, syncope, SAH,
subdural, cervical spondylosis, tumours, hypertensive
encephalopathy, transient global amnesia, vestibular neuritis
Stroke is less likely if headache, fits, LOC or isolated
vertigo
Unlikely CVA
Consider alternate diagnosisand manage appropriately
Step down from Resus assoon as clinically appropriate
Direct admission to Stroke Unit asapInform Medical registrar and
Site Manager
DTA form & copy of notesDrug chartO2 to keep sats 95% (ABG
if clinically indicated)Normoglycaemia(start sliding scale if BM
> 11mmol/L)
NBM if sip swallow test failed
Hydration: prescribe iv fluids if indicatedAspirin: 300mg po or
pr unless contraindicationsClopidogrel: 300mg po if cannot have
aspirin, unless contraindicationBP control: if SBP 200 and / or DBP
120 inform Medical SpR whomust review prior to moving patient to
Stroke Unit
Emergency Department
History Suggestive of Stroke
LAS priority call: OR FAST* signs & symptoms: OR ROSIER*
Score 1 or more:FAST+ve / ?CVA / ?Stroke Facial weakness LOC or
syncope = -1
Arm/leg weakness or numbness Seizure = -1Slurred
Speech/dysarthria Facial weakness = 1
Arm weakness = 1Leg weakness = 1Speech disturbance = 1Visual
field defect = 1
Yes
Follow TIA pathway
Have symptoms resolved? No
HASU Thrombolysis Pathway
Do not arrange CT scanNo bloods except BM
DO NOT NEED TO DISCUSS
Book LAS Critical Transfer
to RLH ED:
0207 902 2511
Send with copy of notes
Note:Intracerebral bleed (not SAH)
also managed by HASUContact Stroke bleep holder
via RLH #6116NO NEED TO CONTACT
NEUROSURGEONS
No Yes
No
* All symptoms and signs areNEW, ACUTE ONSET and,
where relevant, UNILATERAL
Move to ResusInform senior ED Doctor for urgent assessment
CT as soon as patient stableHASU does not accept
intubated patients
Consider CT/bloods/ECG/CXR if nodelay to transfer
Discuss with radiographer, then
request urgent CT brain on EPR
ROSIER of 0 or less makes stroke unlikelybut does not exclude it
seek advice
Stable 24 hours 1 week
Discuss with Stroke Consultanton call via RLH #6116
Insert iv line and keep NBM
Request NUH hospitaltransport
Place patient on CDU waiting fortransport pathway
Request CT/bloods/ECG/CXR ifno delay to transfer
Discuss with radiographer, then
request urgent CT brain on EPR
Does the patient meet the criteria for HASU Thrombolysis
Pathway?1. Haemodynamically stable2. GCS >83. Onset < 4.5
hours4. Age 18-805. BM 3 20 if abnormal, treat and reassess6. Not
on warfarin / no known clotting defect
Does clinical assessment suggest Stroke?
Yes
Stroke Team advise not to transfer / too unstable for
transfer?Investigations: FBC,U&E, serum glucose, clotting, VBG,
CXR, ECG, Urine
Unstable
Call Medical registrar bleep 627ITU Middle grade bleep 087
ABC resuscitation
Stable - up to 24 hours
Discuss with Stroke bleep holderbleep 0806 via RLH #6116Insert
iv line and keep NBM
Request LAS Urgent Care Service totransfer within 2 hours
0207 827 4555Place patient on CDU waiting fortransport pathway
if necessary
ED Clinical Team v4 November 2010 [review November 2012]
