Acute stroke
These documents can be of use in the running of an acute stroke unit and in setting up thrombolysis service. Please click here for training in acute stroke clinical skills and CT interpretation. Some documents have been adapted from other stroke other stroke services. If you use those please acknowledge the source.
West Midlands Ambulance Guidance for pre-alerting FAST positive stroke patients to enable thrombolysis where indicated. Click here for a poster illustrating triage via the FAST test.
Stroke and TIA Pathway for A&E (part 1 of stroke pathway): a clinical pathway with triage for thrombolysis and clerking document for direct admission of stroke patients from A&E to the stroke unit. This is followed by the ASU Medical Clerking Proforma (part 2 of stroke pathway) and the ASU 72 hour pathway (part 3 of stroke pathway).
Thrombolysis pathway for A&E: use this pathway to guide therapeutic thrombolysis. Once thrombolysis has been performed print out the thrombolysis nurse care pathway for monitoring and further management. This must be started immediately and handed over to ward staff at the time of transfer. Complete SITS case record form and enter data on SITS website. Access this link for NIHSS forms and instructions.
Emergency management of complications of thrombolysis: includes instructions for the management of intracranial haemorrhage, extracranial bleeding, orolingual angiooedema, anaphylaxis, hypertension, and reperfusion cerebral oedema.
Thrombolysis Training Folder: this document contains the protocols for therapeutic thrombolysis, the IST-3 protocol, the nursing pathway for thrombolysis, instructions on how to diagnose and treat complications, advice on tricky CTs and FAQs. Click here for a link to the alteplase product characteristics (SMPC).
Endovascular treatments for stroke (e.g. intra-arterial thrombolysis and/or thrombectomy): this is should be considered in large MCA infarcts and in patients with vertebrobasilar artery occlusion. Please click links to access the pathway for intra-arterial thrombolysis, the patient information leaflet, and the form to log each procedure, UHNS data entry file and the intra-arterial thrombolysis nurse pathway. UHNS IAT protocol. UK Consensus statement on IAT and MT.
Endovascular treatment database and audit collaboration data entry sheet (please contact christine.roffe@northstaffs.nhs.uk for password and further information). Local EVT database (copy columns form data entry sheet here to produce local statistics).
Decompressive hemicrainectomy for malignant MCA Syndrome: in young patients with middle large middle cerebral artery infarcts there is a risk of severe fatal cerebral oedema. Please click here for a pathway for decompressive hemicraniectomy.
The SITS thrombolysis register All thrombolysed patients and those who had thrombectomies should be entered into this register to ensure continuing audit of outcome and complications. The case record form can be printed directly form this link. Participation will allow you to compare the results of your center with the rest of the UK and internationally. Other than the number of patients recruited, individual centre data are anonymised for all other users. Please click here to enter a patient into the database, to register your hospital as a SITS centre and get a personal log in.
NICE guidance on Thrombolysis for stroke July 2007. Includes the full HTA appraisal, a summary document, information for patients and carers, as well as a costing template for the business case and recommendations for audit.
The North Staffordshire Stroke Manual: a guide for management of stroke patients from admission to discharge and follow-up aimed at all members of the multidisciplinary team. This is a growing and developing document. Please contact me if you would like to contribute, or if you would like to make corrections (big file 700 KB, takes up to 4 min to download on broadband).
The Stroke Checklist discharge checklist for risk factor management and communication.
Presentation: Developing a service for endovascular stroke treatment
Web presentation: Risks and benefits of thrombolysis
Web presentation: A short Guide to CT After Stroke
Web presentation: Management of Acute Stroke
Web presentation: Diagnosis of acute stroke
Web presentation: Alteplase pharmacology
Web presentation: Indications for thrombolysis
Web presentation: Complications of thrombolysis
Web presentation: Developing Acute Stroke Services
Web presentation: Safe Implementation of Thrombolysis in Stroke
Management of Malignant Middle Cerebral Artery Syndrome (Decompressive hemicraniectomy)
Local policies and files: ASU Draft Operational Policy 7 (2010)