02 Mechanics at a Stroke Code

Key Terms: Code stroke, protocol, intravenous tPA risks, intravenous tPA contraindications, ASPECTS and stroke mimics

Hosts: Ryan Muir, Tess Fitzpatrick, Houman Khosravani

Summary:

In this episode the hosts discuss the approach to the acute assessment of a patient presenting as a code stroke. This episode also reviews the indications, relative contraindications and absolute contraindications to thrombolysis.

• Defining roles within the Code Stroke Team: splitting the team into MD1 and MD2.
  
• Assess patient stability. Airway, Breathing, Circulation, Glucose. Ask yourself is this the type of patient who needs intubation or ICU? Is this the type of patient you may need help from the ER doctor managing vitals?
  
• Examination and NIHSS performed by MD1 while MD2 is collecting collateral information (don’t delay the scan for the full NIHSS, this can be completed later).
  
• Before travelling to the scanner, be prepared: thrombolysis kit and anti-hypertensives
  
• Be on the lookout for “STROKE MIMICS.” Some common stroke mimics are depicted below in the Table 1 Adapted from the 2017 American Academy of Neurology Continuum Article titled, “Clinical Evaluation of the Patient with Acute Stroke.”
  
• ASPECTS score
  
• MD2 to review indications and contraindications to thrombolysis and endovascular therapy
  
• Risks of thrombolysis: hemorrhage, angioedema
  
• Documenting the discussion of consent for thrombolysis and endovascular therapy