Acute Ischemic Stroke Algorithm (tPA Eligibility)
Note: This document provides a structured summary of the Acute Ischemic Stroke Algorithm focusing on tPA eligibility for educational and reference purposes. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines and local protocols.
Recognize signs and symptoms of stroke (e.g., FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911).
ABCs, vital signs, oxygen (if SaO2 < 94%), IV access, blood glucose check, neurological assessment (NIHSS), establish Time Last Known Well (LKW), activate stroke team, transport to stroke center.
Rapidly obtain a non-contrast CT scan to rule out hemorrhagic stroke or other mimics.
CT shows no evidence of hemorrhage or other non-ischemic causes.
Manage according to diagnosis (e.g., hemorrhagic stroke management, treat mimic). tPA is NOT indicated.
Review inclusion and exclusion criteria for IV alteplase (tPA). Key factors include Time LKW, age, stroke severity, recent surgery/trauma, history of bleed, current medications (anticoagulants).
Does the patient meet all criteria for IV alteplase administration?
Calculate dose (0.9 mg/kg, max 90 mg). Administer 10% as bolus over 1 min, remaining 90% as infusion over 60 mins. Monitor closely for bleeding.
Aspirin (unless contraindicated). Consider mechanical thrombectomy if indicated and available. Optimize medical management (BP control, glucose, temperature).
Monitor neurological status, vital signs, blood pressure. Manage complications. Initiate secondary prevention measures. Rehabilitation assessment.
