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    Suspected Stroke: Clinical Management Guideline For

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    izzati94
    1. This document provides a clinical management guideline for patients presenting with suspected stroke symptoms within 7 days. 2. It outlines the assessment and treatment process in the emergency department, including initial medical assessment, imaging, and criteria for thrombolysis versus neurology consultation. 3. Key decisions include determining if symptoms are less than 4.5 hours and patient is eligible for thrombolysis, or if symptoms are greater than 4.5 hours and patient requires neurology consultation, blood pressure management, and monitoring.

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    Suspected Stroke: Clinical Management Guideline For

    Uploaded by

    izzati94
    25 views1 page
    1. This document provides a clinical management guideline for patients presenting with suspected stroke symptoms within 7 days. 2. It outlines the assessment and treatment process in the emergency department, including initial medical assessment, imaging, and criteria for thrombolysis versus neurology consultation. 3. Key decisions include determining if symptoms are less than 4.5 hours and patient is eligible for thrombolysis, or if symptoms are greater than 4.5 hours and patient requires neurology consultation, blood pressure management, and monitoring.

    Original Description:

    Stroke Pathway

    Original Title

    Stroke Pathway

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    1. This document provides a clinical management guideline for patients presenting with suspected stroke symptoms within 7 days. 2. It outlines the assessment and treatment process in the emergency department, including initial medical assessment, imaging, and criteria for thrombolysis versus neurology consultation. 3. Key decisions include determining if symptoms are less than 4.5 hours and patient is eligible for thrombolysis, or if symptoms are greater than 4.5 hours and patient requires neurology consultation, blood pressure management, and monitoring.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    25 views1 page

    Suspected Stroke: Clinical Management Guideline For

    Uploaded by

    izzati94
    1. This document provides a clinical management guideline for patients presenting with suspected stroke symptoms within 7 days. 2. It outlines the assessment and treatment process in the emergency department, including initial medical assessment, imaging, and criteria for thrombolysis versus neurology consultation. 3. Key decisions include determining if symptoms are less than 4.5 hours and patient is eligible for thrombolysis, or if symptoms are greater than 4.5 hours and patient requires neurology consultation, blood pressure management, and monitoring.

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    © All Rights Reserved
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    of 1

    * Susp.

    SAH:
    Clinical Management Guideline for
    1. Any 2 of the 3 clinical features:
    · Headache Neurological deficit
    may / may not be
    SUSPECTED STROKE Patient arrives with symptoms of stroke
    < 7 days duration eg.

    · LOC present · weakness on one side of the body.


    ·
    ·
    incoordination of limbs on one side.
    Meningism · slurring of speech.
    · vertiginous giddiness with slurring of speech,
    2. Isolated headache that is: severe of sudden onset and that Patient presents to ED with · numbness on one side of the body
    is the 1st episode of such pain stroke symptoms · inability to express one’s thought, or to understand
    others.
    · blindness affecting part or all of visual field in one or both
    eyes.
    · double vision or weakness of face and/or limbs.
    CRITICAL CARE OR
    INTERMEDIATE CARE AREA

    Symptoms <4.5 hours Susp. SAH* Symptoms >4.5 hours


    (Thrombolysis possible)

    · Initial medical assessment by ED Urgent CT Scan Pt is alert & BP acceptable by MANUAL


    (Refer to Acute Stroke Thrombolytic Protocol for Inclusion Drowsy or coma or high BP high (>220
    measurement
    & Exclusion criteria) /120 mmHg) by MANUAL measurement
    · Blood investigations
    · Set 2 IV lines
    · Order CT scan

    Start with GTN patch 5-10 mg. Review BP and · Supplemental O2 titirated to SpO2 95%
    manage according to recommendations after CT (or 90% in COLD)
    scan result · NBM
    · Heparin plug with IV Normal saline
    YES Office Hours? NO
    maintenance drip
    (Weekday 8am to · Stat capillary blood sugar
    4.30pm. Exclude
    - aim for normoglycemia
    PH) YES YES · Bloods - FBC, PT, a PTT, urea/
    CT shows
    Consult Neurosurgeon CT
    CT shows
    shows bleed?
    bleed? electrolytes/creatinine, Cardiac
    bleed?
    panel (No GXM)
    · ECG
    Activate AH Stroke NO
    · CXR
    Team (x4000)
    Consult NUH Neurologist · CT head done and seen within 24 hours
    & TRANSFER TO NUH if
    NO
    eligible for thrombolysis
    YES

    CT shows bleed?

    Consult Neurologist Transfer to AH Medical Ward


    NO

    AH Neurologist ED to start TRANSFER TO NUH ED Monitor BP level. th


    assess eligibility, With
    With effect
    effect from 14th July
    from 14 July 2014
    2014
    Activate ambulance thrombolysis & (<185/110mmHg) & activate BP protocol if Approved
    Approved By:
    By: Dr
    Dr Quek
    Quek Lit
    Lit Sin
    Sin HOD
    HOD (Emergency
    (Emergency Medicine
    Medicine Department)
    Department)
    take consent &
    approves for IV
    standby transfer needed Dr
    Dr Gerald
    Gerald Chua
    Chua HOD
    HOD (Department
    (Department of
    of Medicine)
    Medicine)
    rtPA immediately (Refer to Acute Stroke Thrombolytic Protoco) Dr
    Dr Aftab
    Aftab Ahmad
    Ahmad Consultant
    Consultant (Department
    (Department of
    of Medicine)
    Medicine)

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