CodeBlue
Algorithms

Adult ACLS

Acute Stroke

Establish last known well, check glucose, image within 20 minutes, and treat eligible patients with thrombolysis and/or thrombectomy.

Interactive pathway
  1. Assess

    Identify signs of possible stroke

    • BE-FAST: Balance, Eyes, Face droop, Arm weakness, Speech, Time to call
    • Establish time last known well (LKW)
    • Check fingerstick glucose: hypoglycemia mimics stroke
  2. Action

    EMS

    • Prehospital stroke scale (LVO screen)
    • Pre-notify; transport to the most appropriate stroke center
    • Thrombectomy-capable center if LVO suspected and within reach
  3. Action

    ED evaluation: door to imaging ≤ 20 min

    • ABCs; oxygen only if SpO₂ < 94%
    • IV access, labs (do not delay lytics for labs unless suspected coagulopathy)
    • NIHSS
    • Non-contrast CT or MRI, plus CTA for LVO
  4. Decision

    Hemorrhage on imaging?