Stroke Pathway

Emergency Admission

• NWAS FAST +ve
• NWAS Pre Alert A&E
• Complete ROSIER (Within 15 minutes)

 

ROSIER Tool

Loss of conciousness or syncope?

Seizure activity?

Asymmetric facial weakness?

Asymmetric arm weakness?

Asymmetric leg weakness?

Speech disturbance?

Visual Field defect?

Total:

Stroke unlikely but is not excluded and patient should be discussed with the stroke team. DECT phone 21616 – Stroke Specialist Nurse 9-5. Medical SpR – Out of hours.

Inpatient on the Ward (inc. AMU)

Signs/Symptoms

• FAST +ve
• Acute Diplopia
• Acute Vertigo
• Acute Confusion in a previously normal person
• Sudden loss of balance

ROSIER +ve?

Yes

• Inform Stroke team on BLP 547
• Time of onset recorded

No

Consider Stroke as a possible diagnosis

Please be aware that the ROSIER tool will not
identify pure posterior circulation stroke. Consider
the following signs/symptoms and refer to the
stroke team if appropriate:

• Acute Diplopia
• Acute Vertigo
• Acute Confusion in a previously normal person
• Sudden loss of balance

Inform Stroke team on BLP 547

Time of onset recorded

 

Is patient suitable for thrombolysis?

Onset within 4.5 hrs

Yes

• Order CT and Contact CT Control Room 3595. Inform them of ‘Stroke thrombolysis protocol patient’
• If out of hours contact Switchboard and ask them to activate Telestroke Pathway
• Insert 2 cannulas
• Investigations: FBC, U&Es, INR, Glucose,
  Cholesterol
• ECG
• Patient has CT scan en route to ASU (Within 1 hour)
• Thrombolyse Patient

No

• Investigations: FBC, U&Es, INR, Glucose
• ECG
• Order CT Brain Scan
• Patient has CT scan (Within 12 hours)

Transfer to ASU if medically fi (Within 4 hours)

• Screen for swallowing disorder within 4 hours of ASU Admission
• MUST screening within 6 hours of ASU Admission
• Receiving fluids
• Antiplatelet Therapy (after CT scan excludes bleed) within 24 hours of ASU Admission
• OT/Physio screening within 72 hours of ASU Admission
• SLT Swallowing Assessment within 72 hours of ASU Admission