Stroke Pathway (v1.0) - Charlie's EDSTROKE PATHWAY Go to FSH NO YES YES NO YES NO No stroke call YES...

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STROKE PATHWAY Go to FSH NO YES YES NO YES NO No stroke call YES Neurological dysfunction Is the patient SOUTH of the river AND is it 0800-1600 (FSH) CODE 55 STROKE CALL (SJA triggered) Give ETA Search iCM for discharge summaries Accompany patient to CT on SJA trolley Seek out stroke mimics No stroke or head trauma < 3 months ago No previous intracranial haemorrhage No intracranial neoplasm / AV malformation No recent intracranial / spinal surgery No SAH symptoms or history No active bleeding No fever / signs of sepsis No unrelated life threatening illness (eg advanced cancer) ALL of the following must apply Facial palsy “SHOW YOUR TEETH” Arm motor Extend arm 90 0 sitting 45 0 supine Leg motor Extend leg 30 0 supine Head & Gaze Head or eye deviation to one side Aphasia (R side) Follow commands: “CLOSE YOUR EYES” “MAKE A FIST” Agnosia (L side) “WHOSE ARM IS THIS?” (show their affected arm) “CAN YOU MOVE YOUR ARM?” 0 Symmetrical 1 Slight asymmetry 2 Completely asymmetrical 0 Limb upheld > 10 secs 1 Limb upheld < 10 sec 2 Unable to lift against gravity 0 Limb upheld > 5 secs 1 Limb upheld < 5 sec 2 Unable to lift against gravity 0 Normal movements 1 Eye and head to one side 0 Both tasks correct 1 One of two tasks correct 2 Both incorrect 0 Recognize arm and moves 1 Unaware of arm OR not recognize 2 Unaware of arm AND not recognize RACE score 5 or more? Facial weakness Arm weakness Leg weakness Speech disturbance (aphasia / dysarthria) Hemiparesis / hemisensory disturbance Ataxia Diplopia / visual loss Must have AT LEAST ONE of the following Go to nearest hospital NO NO No stroke call YES Was the patient known to be normal 4 hours ago? YES Go to nearest hospital NO NO No stroke call YES Independent premorbid function † (not HLC NH)? YES NO No stroke call Out of hospital From triage Go to nearest TPA centre SCGH, RPH, FSH or Midland NOTE The following are NOT absolute contraindications to thrombolysis / thrombectomy Known cerebral aneurysm (without symptoms SAH Arterial puncture in non-compressible site < 7 days BSL < 2.8, SBP >= 185, DBP >= 110 Isolated neurological signs Dynamic changes in stroke symptoms Age > 80 Severe stroke or previous stroke † Mild-moderate dementia (where stroke resolution would make patient’s care easier) GI or GU bleed < 21 days MI in previous 3 months Postictal post seizure at onset of stroke Pregnancy Major surgery or serious trauma < 14 days Diabetes mellitus Pathway created by Alley / Ercleve / Blacker / NIISWA v1.0 May 2017 CODE 55 STROKE CALL (ED triggered) Prioritize RESUS cubicle IV Cannula FBC, UE, INR (if on Warfarin) Expedite transfer to CT

Transcript of Stroke Pathway (v1.0) - Charlie's EDSTROKE PATHWAY Go to FSH NO YES YES NO YES NO No stroke call YES...

Page 1: Stroke Pathway (v1.0) - Charlie's EDSTROKE PATHWAY Go to FSH NO YES YES NO YES NO No stroke call YES Neurological dysfunction Is the patient SOUTH of the river AND is it 0800-1600

STROKE PATHWAY

Go to FSH

NO

YES

YES

NO

YESNO

No strokecall

YES

Neurological dysfunction

Is the patient SOUTHof the river AND is it0800-1600 (FSH)

CODE 55 STROKE CALL (SJA triggered)Give ETASearch iCM for discharge summariesAccompany patient to CT on SJA trolleySeek out stroke mimics

No stroke or head trauma < 3 months ago

No previous intracranial haemorrhage

No intracranial neoplasm / AV malformation

No recent intracranial / spinal surgery

No SAH symptoms or history

No active bleeding

No fever / signs of sepsis

No unrelated life threatening illness (eg advanced cancer)

ALL of the following must apply

Facial palsy “SHOW YOUR TEETH”

Arm motorExtend arm900 sitting450 supine

Leg motor Extend leg300 supine

Head & Gaze Head or eye deviationto one side

Aphasia(R side)

Follow commands:“CLOSE YOUR EYES”“MAKE A FIST”

Agnosia(L side)

“WHOSE ARM IS THIS?”(show their a�ected arm)“CAN YOU MOVE YOUR ARM?”

0 Symmetrical

1 Slight asymmetry

2 Completely asymmetrical

0 Limb upheld > 10 secs

1 Limb upheld < 10 sec

2 Unable to lift against gravity

0 Limb upheld > 5 secs

1 Limb upheld < 5 sec

2 Unable to lift against gravity

0 Normal movements

1 Eye and head to one side

0 Both tasks correct

1 One of two tasks correct

2 Both incorrect

0 Recognize arm and moves

1 Unaware of arm OR not recognize

2 Unaware of arm AND not recognize

RACE score 5 or more?

Facial weakness

Arm weakness

Leg weakness

Speech disturbance (aphasia / dysarthria)

Hemiparesis / hemisensory disturbance

Ataxia

Diplopia / visual loss

Must have AT LEAST ONE of thefollowing

Go to nearesthospital

NO NONo stroke

call

YES

Was the patient knownto be normal 4 hours ago?

YES

Go to nearesthospital

NO NONo stroke

call

YES

Independent premorbidfunction† (not HLC NH)?

YES

NONo stroke

call

Out of hospital From triage

Go to nearestTPA centreSCGH, RPH, FSH

or Midland

NOTE The following are NOT absolute contraindications to thrombolysis / thrombectomy

Known cerebral aneurysm (without symptoms SAHArterial puncture in non-compressible site < 7 daysBSL < 2.8, SBP >= 185, DBP >= 110Isolated neurological signsDynamic changes in stroke symptomsAge > 80Severe stroke or previous stroke

†Mild-moderate dementia (where stroke resolution would make patient’s care easier)GI or GU bleed < 21 daysMI in previous 3 monthsPostictal post seizure at onset of strokePregnancyMajor surgery or serious trauma < 14 daysDiabetes mellitus

Pathway created by Alley / Ercleve / Blacker / NIISWA v1.0 May 2017

CODE 55 STROKE CALL (ED triggered)Prioritize RESUS cubicleIV CannulaFBC, UE, INR (if on Warfarin)Expedite transfer to CT

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