ACLS Suspected Stroke Algorithm (Acute Ischemic Stroke) - Using the Suspected Stroke Algorithm for Managing Acute Ischemic Stroke

Sep 23, 2026

ACLS Suspected Stroke Algorithm provides time-critical, stepwise actions for suspected acute ischemic stroke in both out-of-hospital and in-hospital settings. It outlines NINDS critical time goals for rapid assessment, CT interpretation, and initiation of fibrinolytic therapy when appropriate. The guidance covers emergency response activation, CPSS/LAPSS neurologic assessment, establishing time zero, ABCs and vital sign evaluation, glucose testing and treatment, NIHSS-based screening, CT/ECG workflow, specialist decision-making on hemorrhage, and post-decision stroke care including tPA risks and anticoagulant/antiplatelet restrictions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Algorithm Steps

Pre-hospital triage and EMS assessments

General assessment in the ED

Immediate neurologic assessment by stroke team

Specialist treatment decisions

Treatment and post-decision care

1-425-449-6793 8AM-5PM Mon-Fri Pacific Time 227 Bellevue Way NE \#458 Bellevue WA 98004 Home Why Choose Us How Our Courses Work FAQ Contact Us Sign Up Now September 15, 2011 ACLS Suspected Stroke Algorithm (Acute Ischemic Stroke) Using the Suspected Stroke Algorithm for Managing Acute Ischemic Stroke Before proceeding, it is a good idea to view our terms . If you would like to go to the main algorithms page, click here . The ACLS Suspected Stroke Algorithm emphasizes critical actions for out-of-hospital and in-hospital care and treatment. National Institute of Neurological Disorders and Stroke Critical Time Goals Included in the algorithm are critical time goals set by the National Institute of Neurological Disorders (NINDS) for in-hospital assessment and management. These time goals are based on findings from large studies of stroke victims: Immediate general assessment by a stoke team, emergency physician, or other expert within 10 minutes of arrival , including the order for an urgent CT scan Neurologic assessment by stroke team and CT scan performed within 25 minutes of arrival Interpretation of CT scan within 45 minutes of ED arrival Initiation of fibrinolytic therapy, if appropriate, within 1 hour of hospital arrival and 3 hours from onset of symptoms Door-to-admission time of 3 hours Algorithm Steps Step 1: Identify signs of a possible stroke. Step 2: Call 911 immediately (activate EMS system) . This is an important step because EMS responders can transport the patient to a hospital that provides acute stroke care and notify the hospital that the patient is coming. The hospital staff can then prepare for efficient evaluation and management of the patient. Currently, half of all stroke victims are driven to the ED by family members or friends. EMS Assessments and Actions Step 3: Complete the following assessments and actions: | Assessments | Actions | | --- | --- | | Define and recognize the signs of stroke. | Support the ABCs (airway, breathing, and circulation) . | | Assess the patient using the CPSS or the LAPSS. | Give oxygen as needed. | | Establish time zero. | Time Zero: set the time when the patient was last known to beneurologically normal. If the patient was sleeping and wakes up with symptoms, time zero is the last time the patient was seen tobe normal. | | Consider triage at a stroke center, if possible. | Transport the patient quickly. | | Assess neurologic status while the patient is being transported. | Bring a family member or witness to confirm time zero. | | | Alert the receiving hospital. | | | Check glucose levels. | General Assessment in the ED NINDS time goal: 10 min [http://www.acls.net/acls-suspected-stroke-algorithm.htm](http://www.acls.net/acls-suspected-stroke-algorithm.htm) Page 1 of 4 Step 4. Within 10 minutes of the patient's arrival in the ED, take the following actions: | Actions | | --- | | Assess ABCs and evaluate vital signs. | | Give oxygen if patient is hypoxemic (less than 92% saturation) . Consider oxygen is patient is not hypoxemic. | | Make sure that an IV has been established. | | Take blood samples for blood count, coagulation studies, and blood glucose. Check the patient's blood glucose and treat if indicated. Give dextrose if the patient is hypoglycemic. Give insulin if the patient's serum glucose is more than 300. Give thiamine if the patient is an alcoholic or malnourished. | | Assess the patient using a neurologic screening assessment, such as the NIH Stroke Scale (NIHSS) . | | Order a CT brain scan and have it read quickly by a qualified specialist. | | Obtain a 12-lead ECG and assess for arrhythmias. | | Do not delay the CT scan to obtain the ECG. The ECG is taken to identify a recent or ongoing acute MI or arrhythmia (such as atrial fibrillation) as a cause of embolic stroke. Life-threatening arrhythmias can happen with or follow a stroke. | Immediate Neurologic Assessment by Stroke Team NINDS time goal: 2

FAQs

What are the key time goals in the suspected stroke algorithm?

The algorithm lists NINDS time goals for immediate assessment within 10 minutes, neurologic assessment and CT within 25 minutes, CT interpretation within 45 minutes, and fibrinolytic initiation within 1 hour of hospital arrival and 3 hours from symptom onset.

What should responders do immediately when stroke signs are suspected?

Identify signs of a possible stroke and call 911 immediately to activate EMS so the patient can be transported to an acute stroke-capable hospital that can prepare and notify care teams.

How do specialists decide whether to give fibrinolytic therapy?

Within 45 minutes, specialists use CT or MRI to determine whether hemorrhage is present; fibrinolytics are considered only if no hemorrhage is found and criteria in the fibrinolytic checklist are met.

Sep 23, 2026

Uploaded by Taylor Morgan