ACUTE ISCHEMIC STROKE PROTOCOL

Step 1-airway breathing circulation.

Step 2-labs for investigating the cause of stroke-CT SCAN-ASPECTS

score(CBP,RFT,ECG,2DECHO,CAROTIDDOPPLER,baseline ABG).

MRI STROKE PROTOCOL if cash paying.

Step 3-history, time zero,NIHSS score,grading of stroke,Is the patient candidate for
thrombolysis?

Step 4-Indications & contraindications for Thrombolysis.

Step 5-blood pressure monitoring for Thrombolysis.

Step 6-if not for Thrombolysis-don`t treat blood pressure unless there is organ
failure.

Step 7-ICU/Ward admission.

Step 8-anti platelet,anti edema,anti seizure prophylaxis,IVF-normal

saline,prokinetics.ryles tube feeds 200ml milk with protein powder +50 ml
water,head end elevation >45 degree`s,lateral nursing,physiotherapy,bed sore
prevention, swallowing test,anti hypertensives from day 2,for malignant infarcts-
decompressive craniectomy with in 48 hours.

Step 9-ECG monitoring,spo2 monitoring-important cause of sudden cardiac death.

Step 10-daily investigations-if decreased UOP-RFT,if tachypnoea-ABG & CXRAY.

Step 11- more vigilant on day 3-4,repeat CT if increasing oedema.

Step 12-watch for any new infections-UTI,pneumonia,DVT,bed sore infection.

Step 13-target shift out of ICU at day 7.

Step 14-daily talk with attenders.

Step 15-if ventilation required-early tracheostomy and care depending on the

severity of stroke.

Department of critical care and emergency medicine