Actions |
Comments |
ABC |
Urgent management of airway, ventilation, and circulation is critical, especially in patients with decreased consciousness. Supplemental oxygen is not recommended for non-hypoxic patients. Consider ITU referral if GCS < 9. Assess NIHSS score. |
Blood Glucose |
Treat and manage hypoglycaemia; a fingerstick test is acceptable. |
Assess for Stroke Thrombolysis |
Consider Stroke Thrombolysis with recombinant tissue plasminogen activator (rt-PA) within 3 hours for patients over 80 or up to 4.5 hours for younger patients. Ensure eligibility with a non-contrast CT scan and a door-to-needle time < 30 mins. |
Assess for Thrombectomy |
For Mechanical Thrombectomy, perform an urgent CTA to identify large vessel obstruction. Ideal window is within 6 hours, with possible extension up to 16-24 hours in select cases. |
Haemorrhagic Stroke or Raised ICP |
Consult neurosurgery as needed. Consider interventions like Shunting, Sub-occipital craniectomy for cerebellar bleeds, or Decompressive Hemicraniectomy for malignant MCA syndrome. |
Haemorrhagic Stroke with Coagulopathy |
Administer 4-factor Prothrombin Complex Concentrates and Vitamin K for Warfarin or DOAC-induced bleeds. Use Praxbind for Dabigatran reversal and platelets for thrombocytopenia. |
Actions |
Comments |
Age of Patient |
Defines the thrombolysis window: patients under 80 can be treated up to 4.5 hours, while those over 80 have a 3-hour window. |
Time Since Last Well |
Determine the time of onset or use the time since last well if onset is unclear. Helps define the treatment window. |
Anticoagulation Status |
Contraindicates thrombolysis but does not exclude thrombectomy. |
NIHSS Score |
Indicates stroke severity. Typically, reperfusion therapies are not offered for minor (NIHSS < 4) or very severe strokes (NIHSS > 25). |
Premorbid State |
Reperfusion therapies aim to reduce dependency; benefits are less if the patient is already highly dependent. |
CT Report |
Avoid referring for thrombolysis or thrombectomy if CT indicates haemorrhage, tumour, or advanced stroke changes. Consult if unsure. |
Comorbidities |
Consider if patient has advanced malignancy or other conditions that may contraindicate treatment. Note any recent bleeding or trauma. |
Blood Pressure |
BP must be < 185/110 mmHg before administering Alteplase. |
Managing and Preventing Early Complications |
Bedside Swallow Assessment |
Assess swallow safety to prevent aspiration. |
Feeding |
Use an NG tube for feeding when appropriate. |
VTE Prevention |
Employ intermittent pneumatic calf compression, LMWH, and early mobilization to prevent VTE. |
Hydration |
Administer IV fluids to prevent dehydration. |
Skin Care |
Frequent turns and monitoring prevent skin damage and ulcers. |
Bowel Management |
Ensure regular bowel movements to prevent constipation. |
Shoulder Protection |
Prevent shoulder injury and postural issues. |
Therapy |
Begin early rehabilitation to support recovery. |
Seizure Management |
Manage seizures promptly. |
Infection Control |
Treat infections like UTIs or respiratory infections. |
Bladder Management |
Focus on continence management and minimize catheter use. |