Standard stroke pathway (First 72 hours) (Guidelines)

• If out with thrombolysis window, then order CT head
• All stroke patients to have Swallow assessment/ensure time & date is documented)
• NIHSS score documented 

• Order CT brain if not done yet and ensure within 12 hours ‘? Stroke’
• If no haemorrhage on CT brain* prescribe stat dose Aspirin 300mg orally or rectally. If NIHSS < or = 3 and not Thrombolysed consider DAPT
• Do not prescribe VTE prophylaxis.​ Instead complete IPC assessment form
• If failed swallow Place NBM and ensure IV fluids prescribed
• Routine bloods + (HbA1c/Lipids/TFTs) and ECG ​
• Admit to stroke ward and follow stroke nursing care bundle (or acute medical ward if no stroke unit)​

• Contact SLT as soon as possible if nil by mouth​
• Consider NG and emergency nutrition (if thrombolysed do this post 24 hrs) - refer to emergency feeding document + refer to dietician​
• If diabetic and NBM refer to Doctor /Diabetic Nurse
• Ensure trauma survey is complete if patient has fallen/long lie/pain​
• Consultant review – this will dictate stroke specific investigations.​
• Ensure bowel and bladder care – bladder USS ​

• Liaise with and refer to PT/SLT/OT/dietician​
• Order stroke specific investigations (do not order carotid imaging unless close to/will be discharged-confirm with stroke services)​
• Waterlow assessment​/Consider airwave mattress

On discharge please refer to nhsh.strokespecialistnurses@nhs.scot

• CT: Computed tomography
• DAPT: Dual antiplatelet therapy
• ECG: Echocardiogram
• IV: Intravenous 
• NIHSS: NIH Stroke Scale
• NBM: Nil by mouth
• OT: Occupational Therapy
• PT: Physical Therapy
• SLT: Speech and language therapy
• TFT: Thyroid function test
• USS: Ultrasound scan
• VTE: Venous thromboembolism