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Ref: 2354 Clinical Director, Emergency Department Page 1 of 2 October 2009

(Attach Label here or Complete Details)

NAME:______________________________________________ NHI:__________

GENDER: ____ DOB:______________ AGE:______ WARD:___________

Christchurch HospitalEmergency Department

Date: Acute Stroke Clinical Pathway

Any patient whose symptoms have completely resolved follow TIA Pathway.

1. INITIAL ASSESSMENT AND MANAGEMENTAction Yes No/NA Comments / Variance Time Sign

Vital signs including: BP, HR, RR, Temp and SpO2 GCS, Limb Power and Pupils Blood glucose level (stat) Cardiac monitor

Use neuro observation chart (QMR0099)

Stroke onsettime Time: Onset not known / on waking

2. THROMBOLYSIS RISK ASSESSMENT

INCLUSION CRITERIA Yes No

Stroke onset time: < 4.5h: 06.00h-22.00h 7 days a week

Age 18-85

Previously independent

Rapid-onset FOCAL neurological deficit: likely due to stroke

Patient able to undergo CT before tPA administration

EXCLUSION CRITERIA Yes No

Comatose / severely obtunded with fixed eye deviation and complete hemiplegia

Oral anticoagulant therapy with an INR of >1.3 (If on warfarin: doURGENTINR)

Blood pressure on repeated measurements: >185 mmHg systolic or >110mmHg diastolic

Recent stroke / head trauma [3 months], ORMajor surgery or internal injury (including MI, organ biopsy) [30 days]OR GI / GU bleed or urinary tract haemorrhage [21days]

Past history of: Intracranial: haemorrhage, aneurysm, AVM (arteriovenous malformation)

3. REVIEW RESULTS OF THROMBOLYSIS RISK ASSESSMENTChoose and commence patient on pathway appropriate to the clinical situation this far:

IfYESto ALLinclusion criteria and NOto ALLexclusion criteria in 2: Follow Potential Thrombolysis Pathway and Acute Stroke Call If NOto ANYinclusion criteria orYESto ANYexclusion criteria in 2: Follow Non-Thrombolysis Pathway Exit if appropriate after taking history

Indicate Pathway Comments Time Sign

Potential Thrombolysis Pathwayand Acute Stroke Call

Use Acute Stroke Register Form

Non-Thrombolysis Pathway Medical Assessment: Use Doctor Initial Assessment Form (C24011A-F)

Other Pathway (specify)

Update PMS: When: InitialAssessment, Management andRisk Assessment completed

602XY: for Rapid Assessment Team (RAT)

Referrals

Potential Thrombolysis Pathway and Acute Stroke Call: Call Acute Neurology Registrar

Non-thrombolysis Pathway:Patients should be admitted under the care of the Neurology Servicewho present with: Progressive or unstable stroke deficits. Younger patients with large strokes who may be at risk of deterioration due to progressive brain swelling. When the diagnosis or aetiology of stroke is of uncertain or unusual kind, including younger patients without traditional vascular

risk factors.OR

Patients should be admitted under the care of the General Medicine (GM) Stroke Team-of-the-daywho present with a stroke: as a manifestation of systemic cardiovascular disease without other acute neurological issues

ACUTE

STROKE

PATHWAY

C1400

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7/23/2019 Acute Stroke Pathway

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Ref: 2354 Clinical Director, Emergency Department Page 2 of 2 October 2009

(Attach Label here or Complete Details)

NAME:______________________________________________ NHI:__________

GENDER: ____ DOB:______________ AGE:______ WARD:___________

4. ONGOING MANAGEMENT

POTENTIAL THROMBOLYSIS PATHWAY and ACUTE STROKE CALL Triage 2 patientsAction Yes Comments / Variance Time SignCall Acute Neurology Reg. Working hours = pager 8111, A/hours = via switch

Call CT - state: Acute StrokeScan (Specify time)

Advance warning to Wd 31: CNS Nurse-in-charge

IV Access 18G:(Apply green sticker in MR2Bwhen inserted in ED)

(When inserted pre-arrival specify):

Gauge Location: ..

Bloods ALL: CBC, U&E, Glucose Coag.

ECG

Obtain Stroke Pack Transport with patient to CTObtainAcute Stroke RegisterForm

Transport with patient to CT

Transit / Nurse arranged

Urgenttransport of patient to CT(Specify time)

NON-THROMBOLYSIS PATHWAY

Referrals Time Sign

Inpatient team referral: (specify) Neurology GM Stroke Team Other:

Action Yes No/NA Comments / Variance Time Sign

IV Access 18G:

(Apply green sticker in MR2Bwhen inserted in ED)

(When inserted pre-arrival specify):

Gauge: Location: ..

Bloods ALL: CBC, U&E, Glucose PRN: Coag.

ECG

Analgesia (inc. Standing Orders)

PRN: IV sodium chloride 0.9%

Fluid Balance commenced

Review by Specialist Reg. Time:

Doctor Initial Assessment Form(C24011A-F) used

Decision to admit Time:

Admissions:Patients of any severity should be admitted to the Acute Stroke Unit (ASU) when they have been assessed by the specialist team in ED.Patients may be admitted via AMAU if they are under the care of General Medicine and have not been fully worked-up in ED.

Action Yes No/NA Comments / Variance Time Sign

Type of bed (Specify) ASU Bed (Wd31) AMAU Other: ...

PRN: Transit nurse

Transferred to ward within 30

minutesof allocation

Reason for delay