ACLS Megacode 4: Stroke

Blood sugar should be checked on all patients with stroke symptoms, as hypoglycemia is a stroke mimic. Administration of glucose in a hypoglycemic patient could rapidly reverse symptoms and spare the patient the risks of unnecessary thrombolytic therapy.

Absolute contraindications to tpa include:

Intracranial hemorrhage on CT

SAH

Neurosurgery, stroke, or head trauma in the last 3 months

Uncontrolled hypertension: ≥ 185/110 mmHg

History of intracranial hemorrhage, AVM, or neoplasm

Active internal bleeding

Platelet count <100,000 or INR > 1.7 or use of anticoagulation

Hypoglycemia (blood sugar <50 mg/dL)

Large stroke: NIHSS > 25 or multilobar stroke on CT

10 minutes to assess, 25 minutes to CT scan, 45 minutes CT read, and 60 minutes to diagnosis.