Stroke

Get your attending! Step 1: Obtain Last Known Well * Stroke treatments including tPA and thrombectomy both require last known well* <3-4.5 hours for tPA* <24 hours mechanical thrombectomy Step 2: Finger Stick Blood Glucose * Hypoglycemia is classic mimic of CVA* Results can be obtained immediately Step 3: STAT Head CT Without Contrast * Poor sensitivity for ischemic stroke* Primary use is identification of hemorrhagic stroke* Required prior to administration of tPA! Step 4: Perform NIHSS * Use calculator (MDCalc) Step 5: Give tPA (If No Contraindications) * Follow department protocol and contraindications* Frequently being updated Additional Reading * tPA Basics (EM Clerkship)* 2013 AHA Stroke Guidelines (AHA)* NIH Stroke Scale/Score (MDCalc)