Stroke

Unfortunately, many patients are not eligible for thrombolytic therapy due to delays in recognition of symptoms, arrival at the hospital, or in assessment or administration of this drug.  Current guidelines support the administration of rt-PA within 3 hours of stroke symptom onset.  Support for thrombolytic therapy is derived from the NINDS rt-PA Stroke Study. [37] Recent evidence has shown benefit for select patients who receive rt-PA within 4.5 hours of symptom onset. [38]

The goal is to complete CT imaging within 25 minutes of patient arrival and interpretation within 45 minutes of arrival.  Laboratory testing should be available in a similar period of time.  If the patient is a candidate for rt-PA, it should be administered within 60 minutes of arrival [door-to-needle]. [33]

Additional testing is routinely performed as part of the care of the stroke patient.  Serum glucose and oxygen saturation may have been obtained by EMS en route.  An electrocardiogram [ECG], complete blood count (including platelets, cardiac enzymes, serum electrolytes, and renal function tests), and coagulation markers [prothrombin time and INR, activated partial thromboplastin time] are routinely obtained.  A pregnancy test should be obtained in females of childbearing capacity.