STROKE THROMBOLYSIS ASSESSMENT PROFORMA

Date of admission: Time of admission:

Location:

Act FAST

A+E TRIAGE Nurse / Recognition Of Stroke In the Emergency Room (ROSIER)
Ring all that apply / YES / NO
Loss of consciousness / syncope / -1 / 0
Seizure activity / -1 / 0
New acute onset (or from sleep) / 1 / 0
Asymmetrical facial weakness / 1 / 0
Asymmetrical arm weakness / 1 / 0
Asymmetrical leg weakness / 1 / 0
Speech disturbance / 1 / 0
Visual field defect / ophthalmoplegia / 1 / 0
TOTAL SCORE / (-2 to 5)

Stroke is unlikely, but not excluded if total score is ≤ 0

If symptoms have resolved within one hour consider TIA as diagnosis and use Trust pathway and Local Referral and Management website http://gp.westernsussexhospitals.nhs.uk/home

A + E Doctor / Date / Time
Time of symptom onset
Time of arrival to A+E
INCLUSION CRITERIA / Yes / No
Clinical signs and symptoms of definite acute stroke?
Clear time of onset?
Presentation within 4.5 hours of onset?
Is the patient aged over 18?

If ALL the inclusion criteria are met,

Call switchboard and ask for a Stroke Thrombolysis call to be put out,

AND follow the pathway overleaf

(If the criteria are not met assess the patient as normal and refer to the Stroke Team immediately.

Stroke Team consists of Stroke Nurse Blp 400 & DOME SHO Blp 971)

A + E Doctor / Immediate Management if for Possible Thrombolysis / Done
Alert CT of likely urgent CT brain scan for potential stroke thrombolysis (ext 85548)
-  Out of Hours ext 85665 or on-call radiographer (Blp 283)
(Radiographer to pre-alert MEDICA to report the scan if in house radiologist is unavailable to do so)
Move the patient to ED Resus room
Intravenous access
Oxygen to keep saturation ≥ 95%
Take blood for FBC, UE, LFT, Clotting, Glucose, Group & Save.
Inform haematology of urgent INR if on anticoagulation therapy. Check patient not
on newer oral anticoagulants. Eg Dabigitran, rivaroxaban, apixaban
Check BM. If BM <3.5 mmol/l treat and reassess
ECG
A + E Doctor /
Stroke Team / Brief History and Examination
Stroke Team / Confirm time of onset accurate.
Brief description of symptoms or NIHSS.
Ring consultant via switch asking to speak to ‘on-call’ stroke Thrombolysis consultant.
Inform CT (Ext 85548/85665 or Blp 283) that urgent scan is now required.
Complete CT Form. Clearly state “For stroke thrombolysis”
If out of hrs set up telemedicine, whilst patient is being scanned.

Do not delay the CT scan – move patient as soon as they are ready

Stroke Team / Check for any Exclusion criteria. (See overleaf)
Start assessing NIHSS.
Ensure IV access present and urgent bloods sent.
Check BM within normal limits.
Obtain weight of patient. Estimate if unable to easily weigh patient.
Check HR, BP, Sats. If SBP>185mmHg or DBP>110 mmHg consider Labetalol.
Speak to family if possible.
Consider drawing up Alteplase bolus.
Inform Bed Manager and ASU to arrange a stroke unit bed.

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Act FAST