Code Stroke

CODE STROKE

Team Members:
Neurology Start Date/Time:
Neurology End Date/Time:
Last Seen Well Date/Time: 
CT First slice:

TNK:
TNK Bolus Time:
TNK Bolus dose:

Puncture time:
First Recanalization time:
First Recanalization TICI:
Final Recanalization time:
Final Recanalization TICI:

Patient Profile:
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Past Medical History:
-
History of Presenting Illness:
-
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-Social History and/or Functional Baseline:

Physical Examination
General exam:
Neurologic exam:
NIHSS Score:   /42 points
Individual Item Points:
Item 1a- Level of Consciousness: x (/3 points)
Item 1b- LOC Questions: x (/2 points)
Item 1c- LOC Commands: x (/2 points)
Item 2- Best Gaze: x (/2 points)
Item 3- Visual: x (/3 points)
Item 4- Facial Palsy: x (/3 points)
Item 5a- Motor Left Arm: x (/4 points)
Item 5b- Motor Right Arm: x (/4 points)
Item 6a- Motor Left Leg: x (/4 points)
Item 6b- Motor Right Leg: x (/4 points)
Item 7- Limb Ataxia: x (/2 points)
Item 8- Sensory: x (/2 points)
Item 9- Best Language: x (/3 points)
Item 10- Dysarthria: x (/2 points)
Item 11- Extinction and Inattention (Neglect): x (/2 points)

Laboratory Investigations:

Imaging:

ASPECTS SCORE = 

Impression:

PLAN:

1)Stroke

Suspected Etiology:

Treatment:

TNK/EVT Inclusions and Exclusions Considerations and Details:

Workup Pending: Lipid Panel, A1C, ECHO, Holter, Outstanding repeat Imaging

Disposition:

Driving:

2) Medical & Critical Care Issues:

Disposition service (Medicine/ICU); other medical issues:

3) Family/SDM Update and Discussions: