The "Golden Hour" of Acute Ischemic Stroke

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Case Study

History:

A 61 year old male, with acute aphasia, right facial droop, and right sided weakness.

12:30	Sudden onset while working in yard.
12:45	Family calls 911.
13:05	Advanced squad evaluates neurologic deficits and glucose.
13:15	Squad notifies receiving hospital of possible stroke patient.
13:30	ED arrival. Initial evaluation by E.D. physician.
13:45	Stroke Team arrives. NIHSS 18.
14:00	CT scan performed.
14:15	Discuss with family and PMD.
14:20	Labs back: gluc 97. BP remains 150/70’s.
14:20	CT reading back. (See below.) No hemorrhage or early signs of ischemia.

14:25	Checklist done. No exclusion criteria met.
14:30	Decision time.
14:35	IV rt-PA given. 0.9 mg/kg total 10% bolus - 9 mg 90% over 1 hr - 81 mg
15:45	Patient goes to ICU. Report personally given to ICU staff.
15:50	Pathway actions begin (HOB, BP parameters, aspiration precautions).

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This presentation was written by Dr. Edward C. Jauch of the Greater Cincinnati / Northern Kentucky Stroke Team at the University of Cincinnati College of Medicine.

Last Revised: March 26, 2001

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