MGH Emergency Department Acute Stroke Protocol for Thrombolysis (IV/IA)

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This protocol was developed and approved by the multidisciplinary Acute Stroke Quality Taskforce and outlines the major responsibilities for the urgent evaluation and treatment of acute stroke patients who present to the ED.

Please refer to other guidelines for the management of inpatients with acute stroke symptoms, or those who present between 6 to 12 hrs after onset of symptoms.

Protocol Activation

Activate the Acute Stroke Protocol for all patients who were Last Seen Well less than 8 hours before ED arrival with acute neurological symptoms. In cases with fluctuating symptoms, those with complex issues, or who are possible research subjects, the protocol should also be activated.

NIH and DPH Recommended Time Targets

The following chart, which outlines the Time Targets mentioned in the Primary Stroke Service Regulations, is included to help hospitals assess the timeliness of activities related to stroke evaluation and diagnosis.

Some of the activities listed below will occur concurrently, and the Department of Health recognizes actual individual timeframes may vary, however the goal for the initiation of IV t-PA remains at one hour from the time of patient arrival in the ED.

The protocol is divided into the following sections:

• IV/IA Pretreatment
• IV t-PA Treatment
• IV t-PA Administration
• IA/Catheter-based
• BP Management
• Special Considerations