When a stroke occurs, time is of the essence as for every minute that ticks by, precious brain cells are lost. Advanced Cardiac Life Support (ACLS) guidelines offer medical professionals both time- and treatment-related goals in assessing and treating a patient who may be experiencing a stroke. These guidelines are explained chronologically below.
Step 1: Identify Stroke Signs and Symptoms
This step is typically performed by the patient or those around him or her. Signs of a stroke include:
• feelings of dizziness
• severe headache
• sudden numbness or weakness on one side of the body
Emergency medical personnel should be contacted immediately if these symptoms occur:
• sudden difficulty seeing in one eye
• trouble concentrating
Step 2: Emergency Medical Personnel Assessment
Once 911 is called, emergency medical services (EMS) personnel engage in the following while transporting a patient to the hospital:
• provide oxygen
• assess and record signs of stroke a patient exhibits
• establish a time when the patient first exhibited symptoms
• notify the hospital that a potential stroke patient is in transport
• measure the patient's glucose levels for signs of stroke
Step 3: Arrival and Stabilization
Once a patient arrives at the hospital, a team stabilizes the patient prior to testing, gathering the following information:
• record vital signs
• provide oxygen
• take blood samples and establish an IV port
• notify the hospital stroke team
• perform a neurologic assessment
• notify the imaging department of the need to take an x-ray and echocardiogram
All of this should take place within 10 minutes of arrival at the emergency department.
Step 4: Assessment
Once the stroke team arrives, they should begin an immediate assessment to confirm the patient has indeed experienced a stroke. The team should review the information gathered by the medical team upon the patient's arrival:
• patient history
• time of symptom onset
• results of the neurologic examination
Following a computed tomography scan, the stroke team should determine if the scan shows signs of brain hemorrhage, which will dictate the next course of treatment.
CT Scan Results
If the brain shows signs of hemorrhaging, a neurosurgeon or neurologist should be called. (If one is not available, the patient should be transported.) The patient should then be admitted to the stroke unit and prepped for surgery to stop hemorrhaging.
Patients who are not experiencing hemorrhaging are once again given a neurologic exam. Patients whose symptoms are improving are not considered to be experiencing a stroke. If the patient's symptoms are deteriorating, the the patient may be given tissue plasminogen activator (tPA), which dissolves blood clots in the brain. Because tPA may only be given up to 3 hours after a stroke has occurred, it is important for patients to seek care as quickly as possible.
Additional Options
If a patient has experienced a stroke more than 3 hours before receiving treatment or cannot receive tPA, the patient is given aspirin and surgical options are considered to reduce brain trauma and damage.
All of these actions--from transport to tPA administration/surgery--should occur within 1 hour of arriving at the hospital, according to ACLS guidelines.
Tags: stroke team, stroke patient, ACLS guidelines, Assessment Once, experienced stroke, experiencing stroke