Signs & Symptoms of stroke:

Sudden numbness or weakness of face, arm or

leg especially on one side of the body
Sudden confusion, trouble speaking or
understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of
balance or coordination
Sudden severe headache with no known cause
This simple test will help you detect stroke
symptoms and Act F.A.S.T.:
F = FACE
Ask the person to smile. Does
one side of
the face droop?
A = ARM
Ask the person to raise both
arms. Does
one arm drift downward?
S = SPEECH
Ask the person to repeat a simple
sentence. The sky is blue
Does the speech sound slurred or
strange?
T = TIME
If you observe any of these
signs, its time
to notify RRT, the charge
nurse and the
patients physician.
Goal Times:
10 minutes - Recognition to MD
25 minutes - Recognition to CT
45 minutes - Recognition to CT, lab, CXR &
EKG results
60 minutes - Recognition to Needle

Signs & Symptoms of stroke:

Sudden numbness or weakness of face, arm or
leg especially on one side of the body
Sudden confusion, trouble speaking or
understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of
balance or coordination
Sudden severe headache with no known cause
This simple test will help you detect stroke
symptoms and Act F.A.S.T.:
F = FACE
Ask the person to smile. Does
one side of
the face droop?
A = ARM
Ask the person to raise both
arms. Does
one arm drift downward?
S = SPEECH
Ask the person to repeat a simple
sentence. The sky is blue
Does the speech sound slurred or
strange?
T = TIME
If you observe any of these
signs, its time

Treatment Windows:
IV t-PA - 0-3 hours (Select patients up to
4.5 hrs)
IA (Intra-arterial) t-PA - 3-6 hours
MERCI retriever/Pneumbra - 6-8 hours
Joint Commission Stroke Guidelines
Strict NPO until swallow screen
obtained (ALL)
Reason documented why IV t-PA not given
(Ischemic)
Antithrombotic therapy end of hospital
day 2 (ASA, aggrenox, plavix, coumadin)
(Ischemic)
DVT prophylaxis end of hospital day 2
(SCDs, heparin SQ/IV, LMWH SQ, coumadin
therapeutic INR) (ALL)
Assessed for &/or received rehabilitation
(ALL)
Discharged on anticoagulation therapy
if A-Fib/Flutter (Ischemic)
Discharged on antithrombotic therapy
(Ischemic)
Discharged on a statin medication
(Ischemic)
Smoking Cessation Counseling (ALL)
Stroke Education (s/s stroke, call 911, risk
factors & modification, meds, need for follow
up) (ALL)
General Guidelines
Allow permissive hypertension (Ischemic)
o
Goal: 15% drop
o IV t-PA Goal: SBP < 185, DBP < 110
o Non t-PA Goal: SBP < 220, DBP <120
Treat source of temperature & lower (ALL)
Maintain Blood Sugar < 150 mg/dL (ALL)
Treatment Windows:
IV t-PA - 0-3 hours (Select patients up to
4.5 hrs)
IA (Intra-arterial) t-PA - 3-6 hours
MERCI retriever/Pneumbra - 6-8 hours
Joint Commission Stroke Guidelines
Strict NPO until swallow screen
obtained (ALL)
Reason documented why IV t-PA not given
(Ischemic)
Antithrombotic therapy end of hospital
day 2 (ASA, aggrenox, plavix, coumadin)
(Ischemic)
DVT prophylaxis end of hospital day 2
(SCDs, heparin SQ/IV, LMWH SQ, coumadin
therapeutic INR) (ALL)
Assessed for &/or received rehabilitation
(ALL)
Discharged on anticoagulation therapy
if A-Fib/Flutter (Ischemic)
Discharged on antithrombotic therapy
(Ischemic)
Discharged on a statin medication

to notify RRT, the charge

nurse and the
Goal Times:
10 minutes 25 minutes 45 minutes EKG results
60 minutes

patients physician.
Recognition to MD
Recognition to CT
Recognition to CT, lab, CXR &
- Recognition to Needle

(Ischemic)
Smoking Cessation Counseling (ALL)
Stroke Education (s/s stroke, call 911, risk
factors & modification, meds, need for follow
up) (ALL)
General Guidelines
Allow permissive hypertension (Ischemic)
o
Goal: 15% drop
o IV t-PA Goal: SBP < 185, DBP < 110
o Non t-PA Goal: SBP < 220, DBP <120
Treat source of temperature & lower (ALL)
Maintain Blood Sugar < 150 mg/dL (ALL)