CODE STROKE

  • ABC

  • PE

    • Gaze Deviation/ Conjugate Gaze Palsy

    • Aphasia (Expressive,Receptive,Global) vs Dysarthria

    • Left/right hemiparesis/Hemiplegia involving face, arm, and leg

  • glucose?

  • Order coagulation labs

  • NIH Score?

    • 0 none | 1–4 minor | 5–15 mod | 16–20 mod–sev | 21–42 severe

  • LKW ? ≤ 4.5 hours?

  • Recent meds, AC (last taken <48 hr)?

  • H/o major surgeries or bleed last 3 mo?

  • reason for admission?

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  • Tele-nuro -> (name, number, epic)

  • PLACE inpatient stork ORDER SETS 3325

  • STATA CT/CTA (CTP? per neuro for thrombectomy if LVO and LKW 6-24 hr)

  • thrombolytic (≤ 4.5 hour,No bleed,<3mo surg, BP<185/110) vs thrombectomy (LVO) if ischmeic

  • if pt stable give your phone number and name and step away

Management:

  • If ICH →

    • Consult NSG

    • ICU attending for transfer

    • (can combine into one call if needed)

    • NSG decides medical vs surgical management

    • Use ICH order set

    • If ICU → SBP 130–150 (<150)

    • If NOT ICU → use Stroke BP order set (2365)

  • If Ischemic Stroke

    • Neurology (Thrombolytic Candidate)

    • Neurology should order thrombolytic

    • ICU attending for transfer -> put transfer order

    • If Thrombectomy Candidate, Neurology calls NIR, If not → ONE Call to connect NIR + Neurology, If at Good Sam-> transfer to Emanuel/ Code 3/ Attending + NIR/ If not ONE Call them

    • USE Ischemic Stroke Order Set

NOTE:

  • put transfer order if going to ICU

  • or storke unite unit 55

  • ask RN, for transfer location

  • update primary if they are staying in place,

  • put orders if Nuro tells you if not ask primary team to follow up and call family

CODE STROKE ORDERS

NURSING ORDERS

  • Diet NPO Time Specified [DIET40] – NPO immediately

  • Vital Signs [NUR490] – q15 min

  • Stroke Neuro Checks [NUR609] – q15 min

  • NIH Stroke Scale [NUR640] – initial + with change + before tPA/thrombectomy (do NOT delay CT)

  • Bedrest [NUR162] – HOB <30°

  • Telemetry Monitoring [NUR225] – continuous

  • Notify Physician – CBG [NUR183] – if glucose <70

  • Notify Physician – Vitals [NUR715] – HR <60, SBP >180, DBP >105

  • Oxygen Therapy [RT51] – NC 1–4 L/min PRN, goal SpO₂ >94%

ALL OTHER ORDERS (CONTINUOUS FLOW)

  • Insert Peripheral IV [IVT3 / 739510] – x1

  • Bacteriostatic Saline [102151] – 0.1 mL intradermal PRN

  • NS Flush [110626] – 5–10 mL BID + PRN

  • Neurology Consult [CON9] – Code Stroke

  • Stroke Coordinator [CON150] – Code Stroke

  • POCT Glucose [POC129] – STAT (treat if <70)

  • Creatinine POC [NUR842] – x1

  • PT/INR [LAB320] – STAT

  • PTT [LAB325] – STAT

  • CT Head WITHOUT Contrast [IMG2826] – STAT

  • CTA Head & Neck WITH/WITHOUT Contrast [IMG2825] – STAT

  • CT Perfusion [IMG1960] – STAT (if available)

  • Naloxone [5373] – 0.4 mg IV PRN

  • Dextrose 25 g IV [4020547] – if hypoglycemia

  • BP Goal (first 48–72 hrs): SBP <180 / DBP <105, avoid >20% drop

  • Labetalol [4020527] – 10 mg IV q10 min PRN (max 2 doses)

  • Nicardipine infusion [4020550] – start 5 mg/hr, titrate q5 min up to 15 mg/hr

ORDER SETS

  • Inpatient Code Stroke (3325)

  • Ischemic Stroke / TIA Add-on (1199)

  • Hemorrhagic Stroke Add-on (008)

  • Stroke Blood Pressure Management (2365)