CODE STROKE
When should you activate a Code Stroke?
When a patient presents with stroke-like symptoms or a positive stroke screen (e.g., FAST or CPSS)?
Sudden 'worst headache of my life' is a classic sign of what type of stroke?
Hemorrhagic stroke (SAH or ICH)
Max time window for IV thrombolytics in most patients?
4.5 hours
First imaging test for all suspected strokes?
Non-contrast CT head
True or False – ED nurses can activate a Code Stroke.
True
How quickly must the physician assess a Code Stroke patient after arrival?
Within 10 minutes
True or False – We still call tele-neurology after a hemorrhage is seen on CT.
True – Always call
Name one absolute contraindication to thrombolytics.
Active internal bleeding (others: surgery, ICH)
After a negative CT, what imaging may follow to find a large vessel occlusion?
CT Angiography (CTA)
Before giving anything by mouth, what screen must be done?
Bedside swallow screen
True or False – Code Stroke is canceled once a CT shows a hemorrhage.
False – Tele-neurology still called
What is the systolic BP goal for intracerebral hemorrhage (ICH)?
140 mmHg
If a patient is within the treatment window and has no contraindications, what is the first thing that must be confirmed before giving thrombolytics?
A non-contrast CT showing no intracranial hemorrhage
(CT must rule out bleeding before IV thrombolytics can be administered.)
If the initial CT is negative but stroke is still suspected, what imaging study is recommended as a follow-up?
What is an MRI of the brain within 12–24 hours of admission, unless contraindicated?
How often are neuro checks done for the first 2 hours after TNK?
Every 15 minutes
Target time to initiate CT scan after arrival?
Within 25 minutes
What is the systolic BP goal for subarachnoid hemorrhage?
160 mmHg (MAP 110)
TNK dosing for ischemic stroke?
0.25 mg/kg IV push, max 25 mg
What is the required follow-up imaging timeframe for admitted stroke or TIA patients if MRI is unavailable or contraindicated?
Repeat CT scan of the head at 24–36 hours after admission.
What position is recommended for hemorrhagic stroke patients?
Head of bed 30°, head midline
Target time for CT interpretation (results)?
Within 45 minutes
Why do we transfer hemorrhagic stroke patients?
Fairchild Medical Center does not have neurosurgical or intracranial pressure (ICP) monitoring capabilities, so transfer is required for definitive care.
What is the 'door to needle' goal for thrombolytic therapy?
60 minutes (goal 30 min or better)
Which stroke type do you never delay CT for other tests?
All suspected strokes – CT first
True or False – Even if CT shows a bleed, you should document 'tele-neurology called.'
True – Part of the protocol