RAH ACUTE STROKE ALGORITHM
Emergency Department Walk-ins
Walk-in Patient arrives in ED with acute ischemic stroke with onset of 6 hours or less OR suspected wake-up stroke with onset of 6 hours or less. (Stroke On-call Physician (SOP) should also be consulted for stroke within 6-24 hours of onset for possible urgent work-up.)
ED
ED Physician contacts SOP & then connects via Tele-stroke as needed SOP calls CT Technologist to arrange acute stroke imaging ED Unit Clerk sends request for CT CT Technologist informs SOP when patient is on the table SOP reviews CT Head on PACS and determines if a CTA is required. If yes, SOP reviews CTA and contacts the On-call Radiologist as needed** SOP contacts ED regarding decision to treat (i.e. thrombolysis: Y/N) SOP contacts UAH On-call Telestroke Physician (through RAAPID) to discuss CTA results. If further intervention required, prepare for transfer to UAH. If no transfer pending, admit for monitoring and follow-up as per Inpatient path. Received tPA
NO tPA
SOP and ED Physician discuss admission
Transfer patient to monitored bed for 24 hours post-tPA SOP contacts IM Sr. Resident to facilitate transfer of care to On-call Medicine Service (use stroke order sets for admission – find in ED) Stroke Unit Team reviews patient next day to facilitate transfer to PCU 53
RAAPID North 1-800-282-9911
RAH CT Tech X-XXXX
Telehealth Connection: established through bridge by both the RAH ED CO and the RAH SOP ** Where SOP has no PACS access, On-call Radiologist can be requested to review CT and approve CTA Stroke Program Edmonton Zone
February 24, 2021