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.
Odna says
Hi,
Do I need to know the NIH stroke scale (15 item screening tool ) for the ACLS testing? There is also Canadian Neurological Scale – Is it used in the practice too? I have never worked at any trauma or emergency settings before. First time getting certified in ACLS, I found your site by accident while I was searching more practice tests and so glad I found it. I will definitely let my colleagues know about this site. Thanks a lot.
Jeff with admin. says
You will not need to know the NIH Stroke scale for ACLS testing. The questions you will encounter will be very general questions which are covered on this site.
Kind regards,
Jeff
Bonnie Villarreal says
Jeff,
Is there a page on your website that shows the interactive site during the actual ACLS course that one could practice navigating? For instance, I am having trouble locating the stroke scale icon to manage an acute stroke patient.
Thanks for the great work!
Bonnie
Jeff with admin. says
I do not have a page like this on the website, but this is a very good suggestion. I will definitely consider adding information about using the AHA online training site. It can be confusing and I think this would help some people.
Kind regards,
Jeff
Abdul-rahaman M. Wunpnini says
Thanks so much for your great job helping health care provides to saving life more grace to your elbow.
God richly bless you.
Ghana
Wunpini. (AEMT)
Phil says
Jeff,
Is the head CT scan should be done 10 or 25 min of ER arrival? Step 3 says 10 minutes while step 5 says 25 minutes. Please clarify. Thank you.
Phil
Jeff with admin. says
The head CT should be ordered within 10 min of arrival in the ER, and the head CT should be completed within 25 minutes of arrival.
Kind regards,
Jeff
UEFA1 says
What interventions are done by the stroke team?
Jeff with admin. says
All of the steps in the pathway after Step 3 are performed by the stroke team. These interventions include: reading the CT, full neurological assessment, administration of fibrinolytic therapy, and admission to a stroke unit. See the full stroke pathway here.
After step 3 if you follow the pathway down the left, that these are the things that will be carried out by the stroke team. You can click on each box to look at details.
Kind regards,
Jeff
priscillaory says
MRI’s are first line choice now. Father in law had a stroke and I asked for a CT. Come to find out MRI’s are done instead. By the way this program is a life saver !!!
Jeff with admin. says
I have not seen any change in the AHA guidelines that put an MRI as the first choice over the CT scan.
I’m so glad that the site has been helpful for you! Kind regards, Jeff
tburt says
What is NIH?
Jeff with admin. says
NIH means National Institutes of Health.
Kind regards,
Jeff
Cecilia says
This is probably assumed upon hospital arrival, but blood work (CBC for platelets, H&H, PT/INR, BMP) must also be ordered. Thank you for excellent review.
nint says
This is a excellent representation of the timeline..thanks,