IV- 12 Circulation December 13. 2005 dentify signs of possible stroke Critical EMS assessments and actions Support ABCs: give oxygen if needed Perform prehospital stroke assessment (Tables 1 and 2) Establish time when patient last known normal ( Note therapies may be available beyond 3 hours from onset Transport; consider triage to a center with a stroke unit if appropriate: consider bringing a witness, family ember, or caregiver Check glucose if possible Immediate general assessment and stabilization Assess ABCs, vital signs Provide oxygen if hypoxemic Obtain IV access and blood samples Check glucos Perform neurologic screening assessment Activate stroke team Order emergent CT scan of brain Obtain 12-lead EC mmediate neurologic assessment by stroke team or designee Review patient history Establish symptom onset Perform neurologic examination(NIH Stroke Scale or Canadian Neurologic Scale) Does CT scan show any hemorrhage? Probable acute ischemic stroke; consider fibrinolytic therapy Consult neurologist or neurosurgeon Check for fibrinolytic exclusions(Table 3) consider transfer if not available Repeat neurologic exam: are deficits rapidly improving to normal? Patient remains candidate for fibrinolytic therapy? Administer aspirin Review risks/benefits with patient and family If acceptable Admit to stroke unit if available Monitor BP: treat if indicated (Table 4) No anticoagulants or antiplatelet treatment for Monitor neurologic status; emergent CT 24 hours Monitor blood glucose; treat if needed Initiate supportive therapy; treat Goals for Management of Patients With Suspected Stroke AlgorithmGoals for Management of Patients With Suspected Stroke Algorithm. IV-112 Circulation December 13, 2005