General Approach to All Patients

Stroke - Suspected

Whenever operationally feasible, Stroke Alert patients should be transported to a Comprehensive Stroke Center. If distance is excessive, or resources are limited, transport to a Primary Stroke Center is an acceptable alternative.

Central Florida Stroke Centers:

  • Florida Hospital-Orlando (Comprehensive)
  • Orlando Regional Medical Center (Comprehensive)
  • Dr. P. Phillips Hospital (Primary)
  • Florida Hospital Altamonte (Primary)
  • Florida Hospital Celebration (Primary)
  • Florida Hospital East (Primary)
  • Florida Hospital Kissimmee (Primary)
  • Florida Hospital Waterman (Primary)
  • Health Central Hospital (Primary)
  • Osceola Regional Medical Center (Primary)

Basic Life Support

  • Supplemental oxygen via nasal cannula only if O2 saturation < 95%
  • Keep head of stretcher at 30-45° elevation (unless spinal trauma suspected)
  • If spinal immobilization is indicated, elevate head of backboard 15°-30°
  • Give nothing by mouth

Advanced Life Support

  • Full ALS Assessment and Treatment
  • For hypotension (systolic BP < 90 mmHg) not improved by fluid boluses, or when fluid boluses are contraindicated
    • Dopamine infusion at 5-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg
  • If hypoglycemic (Blood glucose <50mg/dL for stroke):
    • Dextrose 50% 25 gm slow IV
    • If the patient appears malnourished administer Thiamine 100 mg IV
    • If no IV available:
      • Glucose paste or other oral glucose containing agent (e.g. orange juice) if patient alert enough to self administer oral agent
      • If unable to take oral glucose administer Glucagon 1 mg IM
  • Complete Stroke Alert Screen (see link below):
    • If ALL of the following criteria are met initiate Stroke Alert:
      • The patient has no evidence of trauma
      • The stroke symptoms are new, and onset ≤ 5 hours
      • The initial blood glucose is ≥ 50
      • The patient currently has an abnormal Stroke Examination
    • If patient meets Stroke Alert criteria immediately notify the receiving Stroke Center
    • Report the last time seen normal and note if patient is on anticoagulants (coumadin, etc)
    • If patient does not meet Stroke Alert criteria, transport to closest appropriate facility
  • If seizures occur, refer to seizure protocol

Stroke - Alert Screen/Examination Checklist