Prehospital Stroke Management
Table 4. Stroke Chain of Survival
Detection
Patient or bystander recognition of stroke signs and symptoms
Dispatch
Immediate activation of 9-1-1 and priority EMS dispatch
Delivery
Prompt triage and transport to most appropriate stroke hospital
and prehospital notification
Door
Immediate ED triage to high-acuity area
Data
Prompt ED evaluation, stroke team activation, laboratory
studies, and brain imaging
Decision
Diagnosis and determination of most appropriate therapy.
Discussion with patient and family
Drug
Administration of appropriate drugs or other interventions
Disposition
Timely admission to stroke unit, intensive care unit, or transfer
Table 5. Prehospital Evaluation and Management
of Potential Stroke Patients
Recommended
Not Recommended
Assess and manage ABCs
Do NOT initiate interventions for
hypertension unless directed by medical
command
Initiate cardiac monitoring
Provide supplemental oxygen to maintain
O2 saturation >94%
Establish IV access per local protocol
Do NOT administer excessive IV fluids
Determine blood glucose and treat
accordingly
Do NOT administer dextrose-containing
fluids in nonhypoglycemic patients
Do NOT administer medications by
mouth (maintain NPO)
Determine time of symptom onset or last
known normal, and obtain family contact
information, preferably a cell phone
Triage and rapidly transport patient to
nearest most appropriate stroke hospital
Do NOT delay transport for prehospital
interventions
Notify hospital of pending stroke patient
arrival
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