Adult Suspected Stroke Algorithm During COVID-19 Pandemic

Identify signs and symptoms of possible stroke

Activate emergency response

Critical EMS COVID-19 precautions

• Don PPE
• Limit personnel
• Screen for COVID-19

Critical EMS assessments and actions

• Assess ABCs; give oxygen if needed • Establish time of symptom onset (last
• Initiate stroke protocol known normal)
• Perform physical exam • Triage to most appropriate stroke center
• Perform validated prehospital stroke • Check glucose; treat if indicated
screen and stroke severity tool • Provide prehospital notification; on
arrival, transport to brain imaging suite
Note: Refer to the expanded EMS stroke algorithm.

COVID-19 considerations for ED or brain imaging suite

Immediate general neurologic assessment by hospital or stroke team
• Don PPE
• Limit personnel
• Consider early intubation for patients who have increasing oxygen requirements

ED or brain imaging suite†

Immediate general and neurologic assessment by hospital or stroke team
• Activate stroke team upon EMS notification • Check glucose; treat if indicated
• Prepare for emergent CT scan or MRI of brain upon arrival • Review patient history, medications, and procedures
• Stroke team meets EMS on arrival • Establish time of symptom onset or last known normal
• Assess ABCs; give oxygen if needed • Perform physical exam and neurologic examination,
• Obtain IV access and perform laboratory assessments including NIH Stroke Scale or Canadian Neurological Scale
†
Best practice is to bypass the ED and go straight to the brain imaging suite.

Does brain imaging Yes

Initiate intracranial
show ­hemorrhage? hemorrhage protocol

No

Consider alteplase

Yes
Alteplase candidate?

No
Administer alteplase
Consider EVT
• Perform CTA
• Perform CTP as indicated

Yes No
Rapidly transport to cath lab or
EVT candidate?
transfer to EVT-capable center

Admit to stroke unit or neurological ICU,

Admit to neurological ICU or transfer to higher level of care
or COVID-19 unit or COVID-19 unit

© 2020 American Heart Association