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:
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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: