Code Stroke - Staff Resource Site for Hyperacute Management of Stroke
This page contains relevant Protocols and Quick Reference material that can be used during "Code Stroke" activation.
This is a point-of-care resource and can be accessed easily on your mobile device - consider adding it to your home screen!
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.
IN CASE YOU WISH TO ALSO CALL TO CONFIRM THE PAGES HAVE GONE THROUGH - Below are the folks you can call.
Steps 1-4 Have Now been REPLACED by the Thrombectomy Pages above - these are outlined below just in-case/FYI: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 , 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
Bed flow - During daytime hours - until approx. 7pm - Call 4315
Off hours/weekend and holidays, call Locating - ask for the Shift Manager on-call.
STEP 3) If going for EVT:
MUST CALL AHEAD BEFORE GOING TO ANGIO
Mon-Friday 0700-1900 Ext: 1430 (Angio Recovery Area)
Mon-Friday 1900-0700 Ext: 3532 or 3530 (Angio Control Room)
Weekends, Ext: 3532 or 3530
ensure interventionalist has spoke with Anesthesia - Anesthesia direct number is x. 7878
please call Bed Flow (or Shift Manager during off-hours) - Note that EVT patients need a Level II ICU bed or ICU bed-equivalent after the procedure.
*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  - For Post-TNK/Thrombolysis -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
IF the patient is going to PACU - please go with the patient, Provide in-person report to PACU
After Thrombectomy please call the ICU fellow - for B5ICU:
Between 7AM-4PM - 88112
After 4PM and until 7AM next day - 88114
B4NVU Ward, Level 1, Level 2
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.
Post-TPA ONLY - Level 1 (MRP = Orange Team) -these beds can provide every to every 2 hourly neuro vital signs, there is cardiac monitoring as well, there are no arterial lines, there are no infusions of vasoactive agents including pressors or infusions of labetalol, however certain medications requiring cardiac monitoring such as phenytoin, amiodarone can be provided. Other medications can be given IV, but and intermittent dosing.
Post-TPA and/or Post-EVT Level 2 (MRP = ICU) - these are equivalent to B5ICU beds, these patients can have vasoactive agents, have cardiac monitoring, and can have arterial lines, therefore if the patient requires infusion of vasoactive agents, which typically does require arterial line monitoring, these patients can go to this bed.
Definitions of ICU "levels":
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
ICU Fellow #s - Direct Numbers
ICU CONSULT RESIDENT - 88111
CRCU blue 88197
CRCU green 88118
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
M2 extended ICU 7811
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