Code Stroke


Code Stroke - Staff Resource Site for Hyperacute Management of Stroke

LOCAL Hospital Stroke Protocols

Intranet Clinical Stroke Protocols - please follow this LINK*

NeuroRadiologist Schedule - Code Stroke = Neuro Procedures Rad

EVT CODE STROKES - When Accepting a Patient

Important People to Notify - Follow These Steps:

If you have been phoned and accepted a "Code Stroke" patient to the ED for assessment and treatment, please ensure that you have taken the following steps - ABOVE - with regards to the Thrombectomy NOTICE page, when going to EVT/confirmed, Thrombectomy GO-TO page, and if Cancelling then Cancel Thrombectomy Notice Page.

Steps 1-4 Have Now been REPLACED by the Thrombectomy Pages above - these are outlined below just in-case/FYI:

STEP 1) Call ED Charge/CCL [88093], let them know about the patient, demographics, and to activate a Code Stroke when the patient arrives. Please ask that the patient is brought to a Resuscitation Room, Do Not transfer off the EMS stretcher unless clinically warranted to facilitate for urgent imaging.

STEP 2) Call Bed Flow (or the Shift Manager during off-hours and weekends) to let them know that you have accepted a stroke patient - Let bedflow know you have accepted a patient

STEP 3) If going for EVT:

*The above procedures is slightly modified for in-patient Code Strokes from within our institution - in those instances, please Call Bed Flow or Shift Manager Only (as patient is not going to the ED).

STEP 4) ICU CONSULT [88111] - For Post-TPA -or- Post-EVT patients, please call the ICU Resident for an ICU Consult - please note that this is the first initial Consult Request and "Head's Up" phone call

After Thrombectomy please call the ICU fellow - for B5ICU:

General Considerations for EVT

"General Considerations for EVT" Flow Chart:

Overall, for all vessel occlusions amenable for EVT, a discussion with INR is recommended. "General Considerations for EVT" follows a colour coding: 

DAWN / DEFUSE 3 Criteria - to be used for > 6hr for EVT Consideration

RAPID Training (

Late EVT Window,  Greater than 6 hours (6-24Hrs)

DEFUSE3 criteria

DAWN criteria (core measured CBF<30)

Lastly a word of caution. ALWAYS ensure you look at NCCT to assess hypo-density and correlate this with CBF core recalling that you may have a sub-acute infarct with luxury perfusion (therefore CBF>30 i.e. not showing as core on threshold to CBF map). 

Graphic/table reference: Stroke, G. A., 2018. (n.d.). Use of Imaging to Select Patients for Late Window Endovascular Therapy. Am Heart Assoc.

B4ICU Criteria - Level 1, Level 2

Critical Care Monitoring for specific post-TPA and Post-EVT/TPA patients meeting below criteria

After a code stroke resuscitation, the patient needs a monitored bed for neurologic monitoring.

On the B4 Stroke Unit, there will ultimately be several types of beds.

Definitions of ICU "levels":

Active Research Studies - Inclusion/Exclusion Criteria - Point of Care Reference Material:

Repatriation and Consultation Notes

When patients are repatriated, at times we may want to fax completed notes, beyond the written consultation note. For this purpose, the following ED Fax numbers can be utilized to fax the report:

Hospital ED / FAX #

North York General / 416-756-6793

Mackenzie Health / 905-883-2138

Toronto Western / 414-603-5288

Scarborough and Rouge- General Site / 416-431-8164

Scarborough and Rouge-Centenary Site / 416-281-7455

Other Key Access Points:

ICU Fellow #s - Direct Numbers

Emerg/Float/Rapid 88121
CRCU blue 88197
CRCU green 88118
CVICU 88114
B5ICU 88112 (AM) Overnight 88114 (4PM-7AM M-F, and W/E) - During COVID-19, 88112 for B5ICU and B4ICU Level 2
Rapid Response 7887 - Rapid RN direct access Line

ICU Extensions

B5 4189
D4 7811
C3 4182
C5 4187
CRCU 4196
M2 extended ICU 7811
PACU 4240
Neuroradiology Fellow 1404

Stroke Key Number

B4 main 7870
Team lead on B4 - 89077
Social worker - 5979, pager 8358
Rapid Response 7887
Inpatient pharmacy - 2528
K3E - 4107
Phone in A450 conference - 7187
Laboratory test - 4227
Neuro radiology - Pager 4158 pager NeuroRad Fellow x. 2072

Acute Stroke Coordinator On-Shift

Code Stroke RN On-Shift