ED Stroke Management Process
Suspected or Confirmed Stroke*
These guidelines will be used to initiate the care and treatment of patients
with symptoms of suspected stroke or confirmed stroke. *Stroke refers to any
of three main types: arterial ischemic stroke, cerebral venous thrombosis,
or intracranial hemorrhage from aneurysm or arteriovenous malformation.
If patient has unstable vital signs, unstable airway, ventilation, circulation
or altered mental status, expedite physician assessment. Otherwise:
- Initiate cardio-respiratory monitoring. Vital signs upon admission and
then hourly, if stable. Neuro checks hourly.
- Obtain pulse ox. Administer humidified oxygen via the route best tolerated
by the patient and notify the physician immediately if the pulse ox is
<95% or if mental status is depressed or perfusion or oxygenation are
- Check dextrose stick on admission and every 2 hours. Immediately notify
physician if < 60 or >150.
- Administer Acetaminophen per rectum every 6 hours for fever > 37
- Restrict activity to bed rest with the head of bed flat. Do not allow
child to ambulate or sit upright for toileting or transfer from ED to
radiology. Not needed for neonates and non-mobile infants (<6 months).
- Child must be NPO pending determination about need for sedation, and
assessment of aspiration risk by speech therapy if there is any cranial
- Discuss with patient and parents the need to place an IV and send laboratory
studies to aid in evaluation and treatment.
- Obtain the following labs with IV placement:
- CBC with differential
- Platelet count
- Basic metabolic panel
- Assess the need for a normal saline bolus.
- Start maintenance fluids as soon as possible.
Reviewed: June 2011