Emergency Neurological Life Support Acute Ischemic Stroke Protocol - Version 5.0

Sep 23, 2026

Emergency Neurological Life Support acute ischemic stroke protocol outlining the acute ischemic stroke algorithm, including checklist and communication items for rapid assessment. Provides guidance on IV thrombolysis candidate evaluation, endovascular treatment considerations such as mechanical thrombectomy, hospital admit or transfer decisions, and management pathways based on timing, ABCD2 risk stratification for TIA, NIHSS, and imaging findings (CT/CTA/CTP). Includes sample sign-off narratives and dosing-related administration time documentation expectations for thrombolytics, plus blood pressure targeting and criteria for when neither IV nor endovascular therapy is appropriate.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Acute Ischemic Stroke Algorithm

Checklist

Communication

Acute Ischemic Stroke

IV Thrombolysis Administration

Endovascular Treatment

Hospital Admit or Transfer

Low Risk TIA

High Risk TIA

Onset Less Than 3 hours

Onset Between 3 and 4.5 Hours

4.5 hours">Symptom Onset > 4.5 hours

Emergency Neurological Life Support Acute Ischemic Stroke Protocol Version 5.0 Authors Archana Hinduja, MD Jessica L. Carpenter, MD M Sohel Ahmed, MD Last updated: May 2022 Protocol developed by: Archana Hinduja Acute Ischemic Stroke Algorithm Checklist & Communication ~~ ~~ Acute Ischemic Stroke Table of Contents ~~ ~~ Acute Ischemic Stroke Algorithm ................................................................................................ 1 Checklist ......................................................................................................................................3 Communication ...........................................................................................................................3 Acute Ischemic Stroke ................................................................................................................5 IV Thrombolysis Administration ...................................................................................................6 Once a patient is deemed a candidate for IV thrombolytics ....................................................6 Endovascular Treatment .............................................................................................................7 Consider mechanical thrombectomy .......................................................................................7 Hospital Admit or Transfer ..........................................................................................................8 While waiting for ICU bed ........................................................................................................8 Consider patient transfer if: .....................................................................................................9 Low Risk TIA ............................................................................................................................. 10 ABCD2 Score 0-3 ................................................................................................................... 10 No thrombolysis unless BP is reduced...................................................................................... 11 Blood pressure (BP) exceeds 185/110 mmHg ...................................................................... 11 High Risk TIA ............................................................................................................................ 12 TIA risk moderate or high, or unable to arrange timely outpatient work-up and follow-up .... 12 Onset Less Than 3 hours .......................................................................................................... 13 Time from stroke symptom onset is less than 3 hours .......................................................... 13 Onset Between 3 and 4.5 Hours ............................................................................................... 16 Time from stroke onset is between 3 and 4.5 hours .............................................................. 16 Patient improves following thrombolysis ................................................................................... 17 Measurable improvement within 1 hour? LVO Present or Suspected ................................... 17 Yes-Patient is an IV thrombolysis Candidate .......................................................................... 18 Is Blood Pressure (BP) less than 185/110 mmHg? ............................................................... 18 No: Patient is not an IV Thrombolysis or IA Treatment Candidate ............................................ 19 Neither IV thrombolysis or Endovascular intervention is appropriate .................................... 19 Symptom Onset > 4.5 hours .....................................................................................................20 Outside IV thrombolysis window............................................................

FAQs

What information should clinicians collect during acute ischemic stroke evaluation?

The protocol checklist emphasizes activating the stroke code (if available), recording vital signs, determining time of onset/last known well (LKW), obtaining NIHSS, ordering CT/CTA, and reviewing medication history with focus on anticoagulants and last administration time.

When is IV thrombolysis considered, and what key blood pressure criteria apply?

IV thrombolysis candidacy is determined using the protocol’s pathway, including assessing whether BP exceeds 185/110 mmHg and applying conditions based on the patient’s onset window and treatment eligibility.

How does the protocol guide endovascular treatment decisions?

For endovascular therapy, the protocol calls for considering mechanical thrombectomy and documenting relevant procedure timing such as time to groin puncture, along with recanalization and TICI score assessment.

Sep 23, 2026

Uploaded by Riley West