Suspected Stroke ACLS Algorithm - Updated 2020

Algorithm Notes

Evaluation and Treatment of Suspected Acute Stroke

Pre-Hospital Assessment

1. Identify the signs of a possible stroke.

   • Sudden weakness or numbness, particularly on one side of the body

   • Sudden onset of confusion

   • Difficulty speaking or understanding speech

   • Problems with vision

   • Stumbling and dizziness, loss of coordination or balance

   • Sudden and severe headache without a known cause

2. Call 911 immediately (activate EMS system).

3. Support the airway, breathing, and circulation.

4. Assess the patient using the Cincinnati Prehospital Stroke Scale.

5. Establish time zero.

   FUNDAMENTAL FACT: Time Zero: set the time when the patient was last known to be neurologically normal. If the patient was sleeping and wakes up with symptoms, time zero is the last time the patient was observed to be normal.

6. Consider triage at a stroke center, if possible. Transport the patient quickly.

   CRITICAL CONCEPT: Responders can transport the patient to a hospital that provides acute stroke care and should notify the hospital of the pending arrival of a possible stroke victim. The hospital staff can then prepare for efficient evaluation and management of the patient by activation of the stroke protocol and stroke team when appropriate.

7. Assess the neurologic status while the patient is being transported.

   Bring a family member or a witness to confirm time zero.

8. Alert the receiving hospital.

9. Obtain a finger-stick glucose reading.

Arrival at the Hospital

1. Within 10 minutes of the patient's arrival in the ED, take the following actions:

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