FAST!
Remember: time is brain. Best results occur with treatment started within 2 hours of symptom onset.
- Check to make sure laboratory tests have been sent immediately and EKG ordered (ordered, drawn, and sent within the first 5 minutes).
- Glucose, hemoglobin/hematocrit, and platelets are the only blood tests you need before treatment in most patients.
- Glucose can be by fingerstick.
- Complete blood count (CBC).
- Coagulation studies (PTT, INR) if patient are on anticoagulants or coagulopathy is suspected.
- Some centers now have a finger stick INR.
- Urine pregnancy test if appropriate.
- Examine patient (done within the next 5 minutes).
- Establish clear time of onset.
- Obtain pertinent historical details (e.g., past medical history, medications).
- NIH stroke scale.
- Obtain non-contrast head CT (maximum ED arrival to CT time should be 30 minutes).
- Talk to patient and family to explain risks/benefits.
- Obtain the patient’s weight (ask the patient or family member(s), or estimate).
- If the patient weighs over 100 kg (220 lb) they will get the maximum dose and it is not important to figure out the exact weight.
- Think again: go over indications/contraindications and lab and imaging results.
- Check BP again.
- Pre-therapy: 2 peripheral IV lines.
- Foley catheter (optional).
- Door to needle time: goal is<40 minutes, maximum is 60 minutes.
