Acute Stroke

Unilateral paralysis

Unilateral numbness

Language disturbances

Change in mental status

Visuospatial neglect

Blurred vision

HTN

DM

Afib

Mild= 0-4

Moderate= 5-9

Severe= 10 or >

Hemorrhagic has bleeding in CT

1. Identify signs & Symptoms of stroke

2. Activate EMS 

   1. O2 if Pox <94

   2. Check glucose bc hypo/hyper glycemia can mimic stroke  

3. Immediate general assessment & stabilization

   1. Assess vital signs,labs, ABCs

   2. O2 if Pox <94

4. Immediate neurologic assessment by stroke team

   1. Establish time of symptom onset or last known normal

   2. CT scan to evaluate for hemorrhage 

→Measurable neurologic damage

→18 & up

→80 or younger, no H/O diabetes or CVA, not on DOACs

→NIHSS 25 or less

→Systolic BP>185mmHg or diastolic >110 mg (you can lower it tho)

→Platelet count <100,000

→ INR >1.7, aPTT>40, PT>15

→LMWH treatment dose within 24 hours

→DOAC within 48 hours

→ Current warfarin use & INR >1.7

→Nicardipine

→Labetalol

→Clevidipine

0.9 mg/kg (max dose= 90 mg)

→10% bolus over 1 min

→90% infused over 1 hour

0.25 mg/kg single IV bolus over 5 seconds (25 mg max)

Intracerebral hemorrhage

angioedema

ACEI & ARNI

Hold antiplatelets & anticoags for 24 hours after administering fibrinolytic

Repeat head CT prior to starting AP and AC

Maintain BP <180/105 for at least the first 24 hours after treatment

Must pass swallow study

140-180

Avoid hypoglycemia (<60)