Acute Stroke Assessment and Management
Rapid assessment and management of acute stroke patients
Basic
Neurological
Updated
1/10/2024
Approved By
Medical Director
Version
2024.1
Elapsed
00:00
Indications
- •Sudden onset focal neurological deficit
- •Positive FAST examination
- •Suspected acute stroke within treatment window
Contraindications
- •Clearly established non-stroke etiology
- •Comfort care only patient
Protocol Steps
Follow these steps in sequence for optimal patient care
1
FAST Assessment
Rapid stroke screening examination
CRITICAL
<2 minutes
Actions:
- →Face: Ask patient to smile, check for facial droop
- →Arms: Ask patient to raise both arms, check for drift
- →Speech: Ask patient to repeat phrase, assess clarity
- →Time: Note time of symptom onset or last known normal
Success Criteria:
- Any positive FAST component = high stroke probability
- Document exact time of onset
2
Blood Glucose Check
Rule out hypoglycemia as stroke mimic
CRITICAL
<5 minutes
Actions:
- →Obtain fingerstick blood glucose immediately
- →Treat hypoglycemia if BG <70 mg/dL
- →Reassess neurological status after glucose correction
Success Criteria:
- Hypoglycemia: BG <70 mg/dL
- Normal: BG 70-180 mg/dL
3
Stroke Alert Notification
Early hospital notification for preparation
HIGH
Within 10 minutes of patient contact
Actions:
- →Notify receiving hospital of stroke alert
- →Provide FAST findings and symptom onset time
- →Request stroke team activation
- →Estimate arrival time
4
Supportive Care
Maintain physiological parameters
MEDIUM
Actions:
- →Position with head of bed elevated 15-30°
- →Maintain oxygen saturation >94%
- →Avoid excessive lowering of blood pressure
- →Keep NPO (nothing by mouth)
- →Protect airway if decreased consciousness
Success Criteria:
- BP: Do not lower unless >220/120 mmHg
- O2 sat: Maintain >94%
- Temperature: Treat fever >100.4°F
Required Equipment
•Blood glucose monitor
•Blood pressure monitor
•Pulse oximeter
•Suction equipment
•Oxygen delivery system
Evidence Base & References
- 1.Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines. Stroke. 2019;50(12):e344-e418.
- 2.Jauch EC, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013;44(3):870-947.