DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow

DATE/TIME: [ ] LHH ED [ ] LHGV [ ] In-house ___________ [ ] Others: ____________ [ ] STROKE CODE [ ] CONSULT #

LAST: HPI: EXAM:

COMORBIDS [ ] HTN [ ] DM [ ] HLD [ ] Afib [ ] CAD [ ] CHF [ ] carotid dse [ ] CVA [ ] OSA [ ] smoker [ ] drug use HOME MEDS:

FIRST:

MRN:

LKN

SBP

Glu

CT

CTA LOC [ ] 0 = alert

GAZE [ ] 0 = normal

FACE SYMMETRY [ ] 0 = normal

RT ARM [ ] 0 = no drift

LT ARM [ ] 0 = no drift

ATAXIA [ ] 0 = absent

[ ] 1 = minor stim [ ] 2 = strong stim

[ ] 1 = partial [ ] 2 = forced dev

[ ] 1 = minor [ ] 2 = total lower

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = drift [ ] 2 =some effort

[ ] 1 = 1 limb [ ] 2 = 2 limbs

[ ] 3 = reflex / NR VISUAL FIELDS [ ] 0 = no loss

[ ] 3 = complete on one side

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

SENSORY [ ] 0 = normal

CTP Core [ ] ratio [ ] volume [ ]

LOC Question [ ] 0 = 2 correct

[ ] 1 = part hemi [ ] 2 = full hemi

RT LEG [ ] 0 = no drift

LT LEG [ ] 0 = no drift

[ ] 1 = mild/mod [ ] 2 = severe

DIAGNOSIS: [ ] large vessel dse [ ] cardioembolic [ ] lacunar [ ] other [ ] cryptogenic

[ ] 1 = 1 correct [ ] 2 = none

[ ] 3 = bilat hemi + cortic blind [ ] 1 = drift

[ ] 2 =some effort [ ] 1 = drift [ ] 2 =some effort

EXTINCTION [ ] 0 = normal

LOC Command [ ] 0 = both tasks

LANGUAGE

DYSARTHRIA

[ ] 3= no effort [ ] 4 = no movt

[ ] 3= no effort [ ] 4 = no movt

[ ] 1 = 1 modality [ ] 2 = profound

[ ] 1 = 1 task [ ] 2 = no task

[ ] 0 = normal [ ] 1 = mild/mod

[ ] 0 = normal [ ] 1 = mild/mod

[ ] UN = amput [ ] UN = amput *Visual / tactile / auditory / spatial

*NIHSS >5=disabling *any in red=disabling

[ ] 2 = severe [ ] 3 = mute

[ ] 2 = severe [ ] UN =intubated NIHSS =

Personal inattention

TPA GIVEN: [ ] stroke with measurable neuro deficit [ ] onset <4.5h [ ] age >=18 TPA NOT GIVEN: [ ] OUT OF WINDOW [ ] nondisabling symptoms [ ] NIHSS <6 [ ] ischemic stroke/severe head trauma x 3mos [ ] h/o ICH [ ] h/o brain neoplasm [ ] GI malig / heme x 21d [ ] brain/spine surgery x 3mos [ ] Sx suggests SAH [ ] SBP >=185 / DBP >=110 [ ] active internal bleeding [ ] c/w IE [ ] suspected aortic arch dissection [ ] acute bleeding diathesis [ ] Plt <100K [ ] AC use + INR >1.7 or PT >15s or aPTT >40s [ ] therapeutic LMWH within 24h [ ] DTI or Xa inhib use + lab test (pTT, INR, ECT, TT, Xa assays) [ ] hemorrhage on head CT [ ] extensive obvious hypodensity (irreversible)

TPA NOT GIVEN (cont): Warnings: [ ] only minor signs/ rapidly improving [ ] glu <50 mg/dL [ ] serious trauma past 14d [ ] major surgery past 14d [ ] h/o GIB or GU bleed [ ] seizure with post-ictal impairments [ ] pregnancy [ ] arterial puncture at noncompressible site past 7d [ ] large (>=10mm) unruptured untreated intracranial aneurysm [ ] untreated intracranial vascular malformation Additional for Tx from 3-4.5h: [ ] age >80y [ ] oral anticoag regadless of INR [ ] severe stroke (NIHSS>25) [ ] combi both previous stroke + DM

THROMBECTOMY NOT INDICATED: [ ] out of window THROMBECTOMY: [ ] small core, no heme [ ] CTA/MRA with prox LAO, anterior Within 6h onset [ ] persistent, disabling deficit Within 6-24h [ ] clinical-core mismatch (DAWN) OR [ ] clinical-ASPECTS mismatch (NIHSS >=10, ASPECTS >=6) Within 6-16h [ ] imaging-target mismatch (DEFUSE 3)

DAWN Eligibility: [ ] treatment can start within 6-24h [ ] failed / contraindicated for IV tPA [ ] NIHSS >=10 [ ] baseline MRS <=1 [ ] baseline infarct <1/3 MCA [ ] intracranial occlusion of ICA or M1 [ ] clinical-core mismatch acc. to age

AGE NIHSS VOL (ml)

>=80 >=10 <21

<80 10-19 <31

<80 >=20 <51

DEFUSE 3 Eligibility: [ ] treatment can start within 6-16h [ ] NIHSS >=6 [ ] baseline MRS <=2 [ ] occlusion of cervical / intracranial ICA or M1 [ ] age 18-90y [ ] target mismatch profile on CTP/MRI, i.e. [ ] ischemic core <70 [ ] mismatch ratio >1.8 [ ] mismatch volume >15ml

ADMIT PATIENT: [ ] 7La under svc of ____ [ ] ICU NOT UNDER STROKE: [ ] dispo as per ED [ ] admit to _________ DIZZY/VERTIGO [ ] likely peripheral [ ] dispo pending ED, continued evaluation to resolution of symptoms [ ] outpatient f/u PRN

PLAN: CORE MEASUERS [ ] A1C [ ] lipid profile [ ] TSH [ ] TTE with bubble [ ] TEE [ ] EKG [ ] Holter [ ] telemetry [ ] loop recorder [ ] LE Doppler

ADD’L IMAGING: [ ] MRI head [ ] MRA H&N [ ] carotid US [ ] MRI NOVA [ ] DSA VEEG MISC: [ ] BNP [ ] hypercoag panel [ ] ID tests [ ] hematologic panel [ ] rheum panel

THERAPEUTICS [ ] ASA 81 / 325 [ ] clopidogrel [ ] dual antiplatelet [ ] anticoagulation [ ] heparin gtt, no

bolus, NEURO [ ] therapeutic lovenox [ ] DOAC [ ] Coumadin [ ] atorvastatin _____mg [ ] integrillin drip

SBP goal [ ] <220 [ ] <180/105 [ ] <180 [ ] 140-180 Consult: [ ] Neurosurgery [ ] Neurointerventional team

Transfer to LHH: Admit to [ ] 7La [ ] 7East [ ] ________ [ ] remind OSH to send images on CD [ ] lights and sirens [ ] review vital signs [ ] intubate prior to transfer [ ] load meds (?ASA ?keppra ?reversal)

ABCD Score: [ ] age>=60 +1 [ ] BP>= 140/90 +1 Clinical features [ ] unilat weakness +2 [ ] speech +1 [ ] others Duration [ ] <10m [ ] 10-59m +1 [ ] >=60m +2 [ ] h/o DM +1 *0-3 (low), 4-5 (mod), 6-7 (high)

PATIENT ADMITTED s/o to team

CASE RESOLVED, no need to follow