Stroke Protocol

Medical Directive ID: 
EMG-2014-006
Lead Contact Person: 
Jill Smith
Gina Tomaszewski, Acute Stroke Coordinator, Southwestern Ontario Stroke Network
Physician/Nurse Lead: 
Jennifer Mandzia, MD
Program: 
Emergency Medicine - Emergency Services
Approval By: 
Medical Advisory Committee
Original Effective Date: 
Wednesday, February 15, 2012
Revised Date: 
Wednesday, February 10, 2016
To Be Reviewed Date: 
Sunday, February 10, 2019
This Medical Directive Applies to the following sites: 
LHSC-UH
This Medical Directive Applies to the following patient population: 
Out-Patients
Adults
Order: 

History, physical assessment, vital signs and exact time of symptom onset determined.

 

For suspected stroke symptoms less than 4.5 hours

Triage patient with suspected stroke as EMERGENT or RESUSCITATIVE as condition warrants.  Involve Emergency Department (ED) physician if at any time the patient becomes unstable, or the neurologist notifies the ED that he/she will be delayed.  Patients arriving to the ED via ambulance as a “Stroke Protocol”.

 

See Appendix:  Stroke Protocol.   

 

  Initiate medical directive:

  • Administer oxygen by nasal prong or face mask. Initiate pulse oximetry protocol to maintain saturated oxygen greater than or equal to 92% (delivery device as per goal-oriented oxygen (O2 ) therapy protocol and patient preference).  If patient has a history of chronic obstructive pulmonary disease (COPD) maintain oxygen saturation between 88-92%.
  • Enters Hyperacute Stroke Study in Powerchart [entails CT(Computerized Tomography) head, CTA (CT Angiography) head and neck, CT perfusion if patient has an abnormal creatinine and/or GFR less than and/or equal to 30, or patient has allergy to contrast this may not be done. If patient has a hemorrhagic stroke it may not be possible to obtain a complete study. It may also depend on the discretion of the treating physician].
  • Initiate intravenous access of 0.9% sodium chloride to keep vein open with a minimum 18 gauge needle, preferably in the antecubital fossa of the non-paretic arm for CT; and second IV(intravenous) reserved for Alteplase [tPA(tissue plasminogen activator)] preferably not in the antecubital but in the forearm, and should be an 18 gauge or 20 gauge.
  • Continuous cardiac monitoring.
  • Obtain glucose meter reading
  • Obtain vital signs and neurological vital signs every 15 minutes.  Obtain baseline temperature
  • Draw blood samples (Stroke Care Set)  which includes: complete blood count, electrolytes, urea, creatinine, International Normalized Ratio(INR), Partial Thromboplastin Time(PTT), random glucose, Creatine Kinase(CK), troponin.
  • Obtain STAT 12-lead electrocardiogram(EKG).
  • No food, fluid, or medications by mouth  until a dysphagia screening has been completed
  • Establish End-of-Life Care goals.
Click the link to view the entire medical directive in detail: 

Signatures

SurnameKnown ByDate Signed
AguannoAlainaFeb 14 2017 04:12:11:313PM
AndersonScottFeb 14 2017 11:27:37:920AM
ArbeauRyanMay 27 2016 02:13:59:080PM
BhimaniMunsifMar 14 2017 11:50:25:530PM
BrineMegganJun 29 2016 08:48:36:310PM
BurneoJorgeApr 12 2016 08:58:32:990AM
ChanRichardJul 4 2016 12:04:41:670PM
ChurchKaralynMar 3 2017 03:05:42:913PM
CoomeGrantDec 8 2016 01:07:37:577PM
CooperPaulApr 12 2016 12:37:23:547PM
CunninghamChristyMar 30 2017 08:24:36:757AM
DagnoneRobert VicoMay 16 2016 04:53:55:760PM
DavisMatthewJun 3 2016 12:54:16:230PM
DebickiDerekApr 18 2016 10:44:21:410AM
DiosyDavidApr 25 2016 08:53:37:067AM
DonovanKeithFeb 6 2017 04:37:37:267PM
DreyerJonJun 13 2016 02:54:43:297PM
DukelowAdamMay 25 2016 11:24:25:970AM
EdmondsMarciaMay 29 2016 08:50:13:277AM
El-HalabiWaseemNov 21 2016 09:08:21:520AM
ElsadiSalmanFeb 14 2017 01:27:14:003PM
FingerElizabethMay 29 2016 09:58:13:267PM
FotheringhamMaryApr 4 2018 11:04:47:810AM
FoxcroftLauraMay 16 2016 01:37:46:477PM
FraserAlexApr 8 2016 08:57:16:047AM
FussJeffreyJul 19 2016 10:57:30:493AM
GiffinDawnMay 22 2016 12:46:38:410PM
GoftonTeneilleApr 19 2016 09:38:06:050AM
HamesHeatherJun 27 2016 09:19:06:133AM
HaneyElizabethMay 31 2016 08:30:19:600AM
HassaniBehzadMar 1 2017 10:22:23:170AM
JenkinsMaryApr 8 2016 12:17:54:773AM
JogMandarApr 8 2016 12:42:07:253PM
JonesMichelle-LeeApr 10 2016 09:59:30:390PM
JonesAndrewJun 17 2016 11:41:17:683AM
KhawAlexanderApr 8 2016 12:31:59:070PM
LewellMichaelJul 25 2016 09:41:19:473AM
LoubaniTarekMay 30 2016 12:47:09:167AM
MacDonaldChristieMay 24 2016 03:18:25:687PM
MacDonaldPennyApr 17 2016 12:58:31:583PM
MalSameerJun 22 2016 11:42:04:470AM
MandziaJenniferApr 18 2016 01:16:40:003PM
MaxwellH BrentFeb 16 2017 11:18:50:643AM
McCauleyWilliamMay 24 2016 05:09:28:647PM
McConnellAllisonMar 13 2019 08:04:40:587PM
MeiwaldAllisonJun 1 2016 11:28:15:890AM
MillardWandaDec 12 2016 05:42:14:253PM
MirsattariSeyedApr 8 2016 11:33:32:903AM
MorrowSarahApr 11 2016 11:40:49:483AM
MosdossyGregoryJun 17 2016 03:53:49:157AM
MoulinDwightApr 7 2016 05:17:42:817PM
MurphyDavidMay 30 2016 12:02:43:190AM
MyslikFrankAug 22 2016 11:48:02:980AM
NgVictorMay 15 2016 03:13:56:410PM
NicolleMichaelApr 18 2016 08:15:59:820AM
OuelletteDavidOct 17 2016 02:35:03:453AM
PasternakStephenMay 2 2016 10:30:12:420AM
PeddleMichaelFeb 14 2017 09:30:29:870AM
PillonSylviaMay 31 2016 03:07:21:050PM
PriceLauraMay 30 2016 11:32:14:927AM
PringleDerrickMar 29 2017 03:42:16:173PM
ReddyRameshHave Not Signed
ReganKellyMay 19 2016 11:43:32:013AM
RichardsonChristineJun 6 2016 08:15:07:650AM
RoebothamRoyMay 17 2016 09:47:27:710AM
SedranRobertMay 31 2016 07:33:47:403PM
ShahAmitMay 15 2016 10:05:19:267PM
ShepherdLisaJun 1 2016 07:55:25:710AM
ShoesmithChristenApr 8 2016 05:38:08:873PM
SkoretzTerryMar 2 2017 02:52:01:513PM
SposatoLucianoApr 8 2016 09:10:35:520AM
TanakaPeterMar 15 2017 05:05:27:703PM
TheakstonKarlMar 3 2017 10:07:56:667AM
ThompsonDrewMay 15 2016 10:28:33:263AM
ValdisLaurenAug 28 2017 01:50:56:047PM
VenanceShannonApr 12 2016 10:33:35:980AM
WatlingChristopherApr 8 2016 09:05:15:560AM
WoolfreyKarenMar 28 2017 02:26:36:320PM