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Patients who may qualify:
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Focal neurological deficit of sudden onset within seven hours of symptoms onset or awakening with the symptoms. |
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Arrive at hospital:
(Time 0)
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By ambulance or private car (If ED is notified of a patient fitting these criteria, the Stroke Code could be called prior to ED arrival.) |
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Stroke code called:
(5 min.)
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Triage staff performs abbreviated exam (abbreviated NIHSS). Code is called and team assembles to perform assigned duties of code (ABCs exam, history-screening criteria, lab draw, two IV sites). Telestroke (TS) physician is paged simultaneously with the calling of the code. |
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TS physician calls:
(10 min.)
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TS physician and ED physician discuss case briefly to confirm the need for the stroke code and make decision to connect via video. |
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Connection:
(15 min.)
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Video connection occurs with TS physician accessing via laptop and ED staff starting the videoconferencing cart and signing on. Patient has moved to CT scan and the family and ED physician may review history and initial exam findings with TS physician. |
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Exam:
(20-25 min.)
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Exam (NIH stroke scale) is performed by TS physician with the help of ED physician or ED nurse. History reviewed. CT technician pulls up the CT scan on the PACS system and TS physician reviews with ED physician. |
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Order drug:
(30-40 min.)
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As soon as ICH is excluded with CT review and sufficient confirmation of exam and history obtained – drug is ordered. Review of labs, performing EKG and CXR, and treating BP if needed occur during the wait for drug to arrive. |
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Drug is given:
(45 min.)
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Consent is obtained from patient and/or family verbally. TS physician participates in the review of potential benefits and complications. |
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For patients presenting early with the possibility of receiving drug within 4.5 hours of onset, IV tPA will be considered the first treatment option. If presenting too late to receive treatment in this timeframe, then we will move quickly to transfer for consideration of IA treatment options. Those with severe strokes treated early with IV tPA will also be rapidly transported to consider additional IA treatment following IV tPA.
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The National Brain Aneurysm Center 
