Interventions Within 10 Minutes of Arrival
The receiving hospital should have a written plan for receiving and treating suspected stroke victims. Any plan should emphasize minimizing the delay in diagnosis and treatment of the patient.
Once a suspected stroke patient has arrived at the emergency department (ED), they should be assessed by a qualified healthcare professional within 10 minutes.
Interventions and assessments that should take place after arrival at the ED include:
- Neurological Screening: The neurological screening should be performed within 10 minutes of arrival. The NIH stroke scale is a 15-item screening tool used to determine stroke and stroke severity. The neurologic screening (NIH stroke scale) is more complex than the Cincinnati Stroke Scale that is used in the out-of-hospital setting.
- Order Head CT scan: After obtaining a positive stroke screening, the head CT scan should be ordered (*See Note). No other interventions that are non-life-threatening should delay the CT scan, and the scan should be read by a qualified physician ASAP. (Note: Established stroke protocols in hospitals utilizing an ED triage may allow EMS providers to transport eligible stroke patients directly to CT or MRI and bypass ED admission. Bypassing ED admission for the initial neurologic examination and brain imaging is a best practice strategy for rapid stroke care.)
- Assess and treat ABCs: Upon arrival airway maintenance and cardiovascular status should be assessed and monitored to rule out any underlying life-threatening conditions. Interventions should include a 12-lead ECG to rule out myocardial infarction and arrhythmias. Apply oxygen if necessary to maintain oxygen saturation greater than 94%. Also, IV access can be established at this time if not already completed.
- Activate the stroke team or qualified expert: By the time the CT scan is completed, the stroke team should be ready to perform the rest of the interventions in the stroke pathway if indicated. These interventions include: reading the CT, full neurological assessment, administration of fibrinolytic therapy, and admission to a stroke unit.
- Blood Glucose: If not completed prior to ED arrival, a blood glucose should be obtained to rule out hypoglycemia.
All of the above interventions should take place within 10 minutes of hospital arrival.