The Grampian Stroke Pathway. Acute Stroke Unit. Patient pathway. Patient has stroke/TIA. Red is BAD. NHS 24 . GP. A&E. Clinic. Stroke bleep notified. D.o.M.E. AMAU. Acute Stroke Unit. Decant/ things get missed. Vascular. M.S.T. Community hospitals. Home. Ward 12 WE. Ward 6 WE.
Acute Stroke Unit
Patient has stroke/TIA
Red is BAD
Stroke bleep notified
Acute Stroke Unit
Decant/ things get missed
Ward 12 WE
Ward 6 WE
Care home/ interim care
GP and primary care team
CHSS nurse follow up
Outcome for placebo, rt-PA in clinical trials and SITS-MOST
SITS is a register of thrombolysis in clinical practice
Proportion of patients with good outcomes (0-2) is higher in SITS group than placebo group from clinical trials
(Just in case you need evidence!)
Earlier is better
Patients who have a neurological deficit may be suitable for thrombolysis if they are scanned within 4.5 hours of symptom onset.
Has the patient got an ongoing neurological deficit?
e.g. Facial weakness
Speech disturbance (dysphasia or dysarthria)
Time is brain!
If resolved anterior circulation symptoms and/or AF, discuss with stroke bleep holder re urgent investigation.
Refer other patients to neurovascular clinic (fax letter to 559506)
Known time since onset <4.5 hours?
No contraindication to thrombolysis?**
Time since onset >4.5 hours or
Arrange urgent CT scan
contact stroke bleep via switchboard
(If no response, contact Dr Macleod on page 3132, tel 645250 or 07771631243)
Contact stroke team to arrange admission
**Contraindications to thrombolysis
Minor neurological deficit or symptoms rapidly improving before start of infusion.
Symptoms of ischaemic attack began more than 4 hours prior to referral, or when time of symptom onset is unknown.
Severe stroke as assessed clinically (e.g. NIHSS>25) and/or by appropriate imaging techniques.
Seizure at onset of stroke.
Symptoms suggestive of subarachnoid haemorrhage, even if the CT-scan is normal.
On warfarin therapy, or administration of heparin within the previous 48 hours and a thromboplastin time exceeding the upper limit of normal for laboratory.
Patients with any history of prior stroke and concomitant diabetes.
Prior stroke within the last 3 months.
Platelet count of below 100,000/mm3 (if available).
Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, or aggressive management (IV medication) necessary to reduce BP to these limits.
Blood glucose <3 or > 20 mmol/L.
Known haemorrhagic diathesis, manifest or recent severe or dangerous bleeding, known history of or suspected intracranial haemorrhage.
We are a TEAM!!
Links with Woodend
Speech & Language
Mobile stroke team