Adult stroke algorithm | ACLS-Algorithms.com

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  1. Soumyamol Joy says

    I have recently did my ACLS and successfully passed. At the start had no idea what is it all about and start practicing on for two weeks and passed the course. Simple and constructive way of teaching made everything easy and fun. Enjoyed the whole studies and will recommend to everyone. Thank you so much.

  2. SUSAN ISAAC says

    Jeff,
    Thank you, for clearing the doubt of giving aspirin.

    So it’s given if the pt. is NOT a candidate for fibrinolytic therapy and there is NO hemorrhage.

    regards,
    Susan.

      • Stephanie Ahmadi says

        What if ASA was already given outside of the hospital and they are otherwise a candidate for Fibrinolytic therapy?

      • ACLS says

        The administration of aspirin in the prehospital setting would not change the status of the patient regarding being a candidate for fibrinolytic therapy. They could still be given fibrinolytic therapy.

        Kind regards,
        Jeff

  3. Barbara Pezzengrilli says

    I WORK IN A STROKE UNIT AND OF COURSE ASA WOULD NOT BE GIVEN IF THERE WERE A BLEED, BUT WHEN I LOOK AT THE ALGORITHM IT LOOKS AS IF IT IS PART OF THE HEMMORAGHIC TREATMENT. IT REALLY NEEDS TO BE CHANGED.

    • Jeff with admin. says

      In the diagram, as indicated by the arrows, the ASA is only given to a patient that does not have a head bleed but do not qualify for fibrinolytic therapy. There is no arrow connecting ASA to the head bleed, and it would only be for non-head bleed patients that do not qualify for fibrinolytic therapy. Kind regards, Jeff

  4. Lee Sherman says

    Found above to be helpful, will use it to help r/o CVA and expedite tx when CVAs occur, thank you.

  5. Rob Casserley says

    Jeff
    I am really unclear in the ACLS guidelines about thrombolysis in situations of ‘soft neurological defecit’, with otherwise all thrombolytic criteria fulfilled, eg – left arm and leg parasthesiae starting within 3 hours – with resolution of the arm symptoms after 2 hours but persisting leg altered sensation. Head CT no bleed. From the patient perspective there is a hard neuro defecit – harder to confirm objectively. Does this patient default to being a thrombolysable candidate(?) or as there is no m otor defecit, she is non-thrombolysable(?) or because she has shown signs of improvement already – should one postpone thrombolysis, even though there is a subjective hard neuro defecit? Risks vs benefits of thrombolysis etc…

    Thanks for your feedback.

    Additionally – do you feel that all CT heads should be with contrast these days. It is a hard argument to make with our radiologists – but would ssem to make sense when trying to ‘rule in’ thrombotic stroke

    Best

    Rob Casserley

    • Jeff with admin. says

      I’m definitely not an expert or even experienced with stroke care protocol. I did run this by my brother how contributes to the site and is a critical care nurse specialist. He forwarded this stroke care protocol to me and thought that it might be helpful for you in your understanding.
      Regarding the head CT. Currently in the United States, noncontrast computed tomography (CT) remains the primary imaging modality for the initial evaluation of patients with suspected stroke.
      Kind regards,
      Jeff

  6. Sharon Draveling says

    If a patient is already taking Aspirin 325mg/day or 81mg/day do you given an additional dose of Aspirin in the event of possible stroke or heart attack?

    • Jeff with admin. says

      The ASA is only given for the ischemic stroke patient who does not qualify for fibrinolytic therapy. These patients are treated in the same pathway as the hemorrhagic stroke patients but if you look closely, the ASA is not in the path that the hemorrhagic stroke patients take. It is on the side is is only reserved for the ischemic stroke patients who do not qualify for fibrinolytic therapy.
      Kind regards,
      Jeff

  7. Mary DB says

    A 80 year old female with a previous diagnosed haemorrhagic stroke 2 years back comes with recurrent TIA : should ASA be given as a part of treatment and also for prevention of recurrent strokes?

  8. MARLON says

    Hi Jeff, when do we need to add up antiplatelet like clopidogrel in ischaemic stroke? Will it not be necessary to give in early treatment? Thanks.

    • Jeff with admin. says

      1. Detection: Rapid recognition of stroke symptoms
      2. Dispatch: Early activation and dispatch of emergency medical services (EMS) system by calling 911
      3. Delivery: Rapid EMS identification, management, and transport
      4. Door: Appropriate triage to stroke center
      5. Data: Rapid triage, evaluation, and management within the emergency department (ED)
      6. Decision: Stroke expertise and therapy selection
      7. Drug: Fibrinolytic therapy, intra-arterial strategies
      8. Disposition: Rapid admission to stroke unit, critical-care unit
      9. Here is a page about the H’s and T’s of PEA: H’s and T’s of ACLS

        Kind regards,
        Jeff
        http://www.acls-algorithms.com

  9. Elaine12 says

    I am not clear on the aspirin.So you give the ASA if the pt is not a candidate for fibrinolytic therapy,and there is no hemorrhage?

    • Jeff with admin. says

      If you look where the Aspirin on the algorithm, a head CT has already ruled out “head bleed” in he case that ASA is given. You are crossing over to the “right branch stroke hemorrhage pathway” at a later time in the algorithm and “head bleed” would have already been ruled out. Does that make sense?
      Kind regards,
      Jeff

  10. nint says

    Jeff..according to the stroke algorithm …would aspirin be administered for a hemorrhagic stroke? Doesn’t seem like this would be indicated.

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