Skip to main content

Suspected Stroke Clinical Pathway, Emergency Department – Initiate Neuroprotective Stroke Protocol

Suspected Stroke Clinical Pathway — Emergency Department

Neuroprotective Stroke Protocol

Use these guidelines to initiate the care and treatment of children with symptoms of suspected or confirmed stroke.

Neuroprotective interventions include the following:

Target Monitoring
Normotension CR monitor, VS hourly or more frequently as clinically indicated
Normovolemia
  • IV maintenance fluid
    • NS may add dextrose for infants < 6 mos
  • NS bolus, as clinically indicated
Normal Oxygenation Maintain pulse ox > 95% in most cases
Neurologic Assessment Neuro check hourly
Normoglycemia
  • Monitor POC glucose on admission and q2hr
  • Notify MD if < 60 or > 150 mg/dL
Normothermia
  • Maintain temp < 38°C
  • Measure q2hr
  • Administer acetaminophen as needed
Seizure Control
Activity
  • NPO
  • Restrict to bed rest
    • Suspect ischemic stroke: HOB flat
    • Suspect CSVT or ICH: HOB up 30°C
  • Do not allow ambulation or upright sitting for toileting or transfer to Radiology
  • Not needed for infants < 6 mos

Initial Diagnostic Studies

Initial Laboratory and Risk Factor Evaluation
  • POC glucose
  • CBC with differential
  • PT/PTT/INR
  • BMP
  • EKG
  • HCG as indicated
Initial Radiographic Evaluation
  • CT vs. MRI
  • Follow Stroke Team recommendations

 

Jump back to top