(Attach Label here or Complete Details)

A
C
U
T
E

NAME:______________________________________________ NHI:__________
GENDER: ____

Christchurch Hospital
Emergency Department

DOB:______________

AGE:______

WARD:___________

Acute Stroke Clinical Pathway

Date:

Any patient whose symptoms have completely resolved follow TIA Pathway.

1. INITIAL ASSESSMENT AND MANAGEMENT

Action

Yes

No/NA

Vital signs including:

BP, HR, RR, Temp and SpO2
GCS, Limb Power and Pupils
Blood glucose level (stat)
Cardiac monitor
Stroke onset time

Comments / Variance

Time

Sign

Use neuro observation chart (QMR0099)

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

S
T
R
O
K
E

No

Comatose / severely obtunded with fixed eye deviation and complete hemiplegia
Oral anticoagulant therapy with an INR of >1.3 (If on warfarin: do URGENT INR)

P
A
T
H
W
A
Y

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

Recent stroke / head trauma [3 months], OR Major 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 ASSESSMENT

Choose and commence patient on pathway appropriate to the clinical situation this far:
If YES to ALL inclusion criteria and NO to ALL exclusion criteria in 2: Follow Potential Thrombolysis Pathway and Acute Stroke Call
If NO to ANY inclusion criteria or YES to ANY exclusion criteria in 2: Follow Non-Thrombolysis Pathway
Exit if appropriate after taking history

Indicate Pathway

Comments

Time

Potential Thrombolysis Pathway

and Acute Stroke Call

Use Acute Stroke Register Form

Non-Thrombolysis Pathway

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

Sign

Other Pathway (specify)

Update PMS: When: Initial
Assessment, Management and
Risk 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 Service who 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-day who present with a stroke:

as a manifestation of systemic cardiovascular disease without other acute neurological issues

Ref: 2354

Clinical Director, Emergency Department

Page 1 of 2

October 2009

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0
1
4

(Attach Label here or Complete Details)

NAME:______________________________________________ NHI:__________
GENDER: ____

DOB:______________

AGE:______

WARD:___________

4. ONGOING MANAGEMENT
POTENTIAL THROMBOLYSIS PATHWAY and ACUTE STROKE CALL Triage 2 patients
Action

Yes

Call Acute Neurology Reg.

Comments / Variance

Time

Sign

Time

Sign

Time

Sign

Working hours = pager 8111, A/hours = via switch

Call CT - state: Acute Stroke

Scan (Specify time)
Advance warning to Wd 31:

IV Access 18G:
(Apply green sticker in MR2B
when inserted in ED)

(When inserted pre-arrival specify):

Gauge

Bloods

ALL: CBC, U&E, Glucose Coag.

CNS

Nurse-in-charge

Location: ..

ECG
Obtain Stroke Pack

Transport with patient to CT

Obtain Acute Stroke Register

Form

Transport with patient to CT

Transit / Nurse arranged

Urgent transport of patient to CT
(Specify time)

NON-THROMBOLYSIS PATHWAY
Referrals
Inpatient team referral: (specify)

Action

Yes

Neurology
No/NA

GM Stroke Team

Other:

Comments / Variance

IV Access 18G:
(Apply green sticker in MR2B
when inserted in ED)

Gauge:

Bloods

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

(When inserted pre-arrival specify):

Location: ..

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
Type of bed (Specify)

Yes

No/NA

Comments / Variance

ASU Bed (Wd31)

Time

AMAU

Sign

Other: ...

PRN: Transit nurse

Transferred to ward within 30
minutes of allocation
Reason for delay

Ref: 2354

Clinical Director, Emergency Department

Page 2 of 2

October 2009