Step 9: ACLS Stroke Protocol
Whether the patient has an ischemic stroke or a hemorrhagic stroke there are some general guidelines that are followed after initial treatment in the emergency department. Primary interventions include support of the the airway, breathing, circulation, vital signs, and ongoing neurologic assessment. If fibrinolytic therapy was initiated, the patient should be monitored for bleeding.
Other important interventions include dysphagia screening and regular blood glucose checks. The patient should also be transported to an appropriate level of care.
A growing body of evidence indicates that hyperglycemia worsens clinical outcomes in patients with ischemic stroke. Evidence also indicates that control of hyperglycemia with insulin in critically ill patients improves survival rates. In light of this, AHA now recommends considering the use of intravenous or subcutaneous insulin to control blood glucose level in stroke victims.
Ongoing Neurological Assessment
In both the ischemic stroke and the hemorrhagic stroke, the patient should be monitored for neurological changes. For the patient with ischemic stroke receiving fibrinolytic therapy, neurological changes could indicate intracranial bleeding or worsening ischemic stroke. For the patient with hemorrhagic stroke, worsening neurological changes could indicate further complications related to intracranial hemorrhage.
After fibrinolytic therapy has been initiated, the patient’s blood pressure must be controlled to keep the systolic blood pressure less than or equal to 185 mmHg and the diastolic blood pressure less than or equal to 110 mmHg. This lowers the risk of hemorrhage related to the use of rtPA.