ADULT DRUG REFERENCE - EMSA
|G20 |INTERFACILITY TRANSFER OF STROKE PATIENTS |
|GENERAL | |
|Patients with acute stroke that may not qualify for thrombolytic therapy or that may not respond to thrombolytic therapy, necessitating |
|transfer for potential interventional care |
|OXYGEN |BLS: Low flow unless ALOC / respiratory distress / shock |
| |ALS: Titrate to SpO2 of at least 94% |
|Cardiac Monitor | |
|Monitor Vital Signs |Monitor blood pressure and Glasgow coma scale at least every 15 minutes. Use pulse oximetry - consider |
| |non-invasive end-tidal carbon dioxide monitoring if any respiratory difficulty. |
|Monitor IV |Maintain TKO or other existing flow rate |
|Prompt Transport |Transfer for definitive care is the priority in stroke patients. Minimizing time delay is essential. |
|Key Treatment Considerations |
|Stroke patients who are transferred may have already received thrombolytic therapy or may not have qualified for thrombolysis based on length|
|of time from stroke onset or other medical contraindications |
|Ongoing administration of thrombolytic therapy requires additional qualified staff (nurse or physician) for transport |
|Thrombolytic therapy in stroke patients is associated with around a 6% incidence of symptomatic intracerebral hemorrhage, and around a 1% of |
|serious hemorrhage elsewhere |
|Close monitoring is important. Significant changes in patient vital signs/GCS during transport should be reported immediately to receiving |
|facility staff as it may affect immediate treatment: |
|Hypotension may occur because of external or internal hemorrhage |
|Hypertension may be related to acute intracranial process or underlying disease |
|Respiratory depression or airway compromise may occur due to stroke or intracerebral hemorrhage |
|Decreasing level of consciousness may occur due to stroke or intracerebral hemorrhage |
|Cardiac dysrhythmias may occur in stroke patients (bradycardia or tachyarrhythmia) |
|Observe for external hemorrhage in patients with prior administration of thrombolytics. Place direct pressure if hemorrhage noted. |
|Related guidelines: Shock/Hypovolemia (A10), Altered level of consciousness (G2), Respiratory Depression or apnea (G12) |
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