Suspected Stroke Algorithm - 2025 Guidelines Coming Soon

When someone shows signs of a stroke, every second counts. A swift and accurate response can make a massive difference in their recovery. This is where a suspected stroke algorithm becomes essential. It’s a clear, step-by-step guide that helps first responders and healthcare professionals quickly assess a person and start the right care.

Understanding the stroke algorithm is not just for medical professionals. Anyone can learn the basics, which can empower you to act confidently in an emergency. The goal is to get the patient to the right facility as fast as possible, because when it comes to a stroke, time is brain.

What Is a Stroke?

Before we explore the algorithm, let’s quickly review what a stroke is. A stroke happens when the blood supply to part of the brain is cut off. Without blood, brain cells are deprived of oxygen and start to die. This can lead to lasting brain damage, long-term disability, or even death.

There are two main types of strokes:

Ischemic Stroke: This is the most common type, making up about 87% of all strokes. It occurs when a blood clot blocks an artery that supplies blood to the brain.
Hemorrhagic Stroke: This type happens when an artery in the brain leaks blood or ruptures. The leaked blood puts too much pressure on brain cells, causing damage.

Recognizing the signs of a stroke and acting quickly is the best way to improve a person’s chances of a good outcome.

Suspected Stroke Algorithm Step-by-Step Guide

The suspected stroke algorithm is a structured protocol designed for pre-hospital and emergency settings. It ensures that potential stroke patients are identified quickly and managed appropriately. While different organizations might have slightly different versions, the core steps are consistent and based on widely recognized assessment tools.

Step 1: Initial Assessment (BE-FAST)

The first step is to recognize the common signs of a stroke. The BE-FAST acronym is a simple and effective tool for this. It prompts you to check for specific symptoms:

B – Balance: Has the person suddenly lost their balance or coordination? Are they dizzy or having trouble walking?
E – Eyes: Is there sudden trouble seeing in one or both eyes? This could be blurred, double, or lost vision.
F – Face Drooping: Does one side of the face droop or feel numb? Ask the person to smile. Is their smile uneven?
A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S – Speech Difficulty: Is their speech slurred? Are they unable to speak or hard to understand? Ask them to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
T – Time to Call 911: If you see any of these signs, even if the symptoms go away, it’s time to call 911 immediately. Note the time when the symptoms first appeared.

This initial check is the starting point of the suspected stroke algorithm. A positive finding for any of these signs should trigger an emergency response.

Step 2: Emergency Medical Services (EMS) Actions

Once EMS arrives, they continue the assessment and begin critical pre-hospital care. Their actions are guided by the algorithm to ensure nothing is missed.

Confirm Signs and Note Time: Paramedics will re-assess using a formal stroke scale, like the Cincinnati Prehospital Stroke Scale (CPSS) or the Los Angeles Motor Scale (LAMS). They confirm the time of symptom onset, which is crucial for determining treatment options.
Vital Signs and Glucose Check: They will check the patient’s airway, breathing, and circulation (the ABCs). They also check blood glucose levels, because low blood sugar (hypoglycemia) can mimic stroke symptoms.
Establish IV Access: An intravenous (IV) line is started to allow for the administration of fluids or medications if needed.
Pre-notification to Hospital: EMS will notify the receiving hospital that a potential stroke patient is on the way. This “stroke alert” allows the hospital’s stroke team to prepare, saving valuable time upon arrival.

Step 3: Emergency Department (ED) and Stroke Team Actions

When the patient arrives at the hospital, the stroke team takes over. The algorithm ensures a seamless transition and rapid evaluation.

Immediate Assessment: The patient is assessed by a physician within 10 minutes of arrival. This includes a neurological exam.
CT Scan: A non-contrast CT scan of the head is performed within 20 minutes of arrival. This is one of the most critical steps. The CT scan helps determine whether the stroke is ischemic (caused by a clot) or hemorrhagic (caused by bleeding). The treatment for each type is very different.
Interpret CT Scan: A radiologist or physician interprets the CT scan results within 45 minutes of the patient’s arrival.
Blood Work: Blood tests are run to check for other potential causes of the symptoms and to ensure there are no contraindications to treatment.

Step 4: Treatment Decisions

Based on the CT scan results and the patient’s condition, the team decides on the best course of action.

For Ischemic Stroke: If the CT scan shows no bleeding and the patient is within the treatment window (typically 3 to 4.5 hours from symptom onset), they may be a candidate for tissue plasminogen activator (tPA). This is a clot-busting drug that can restore blood flow to the brain. In some cases, a procedure called a mechanical thrombectomy may be performed to physically remove the clot.
For Hemorrhagic Stroke: If the CT scan shows bleeding, tPA is not given as it would worsen the bleeding. Treatment focuses on controlling the bleeding, reducing pressure on the brain, and managing blood pressure.

The goal is to administer treatment as quickly as possible. For tPA, the target is “door-to-needle” time of 60 minutes or less.

Why the Algorithm Is So Important

The suspected stroke algorithm provides a standardized, efficient, and evidence-based approach to stroke care.

Saves Time: In a stroke, millions of brain cells die every minute. The algorithm streamlines the process from the first sign of symptoms to treatment, minimizing delays.
Improves Accuracy: It ensures that all critical steps are followed, reducing the chance of misdiagnosis or missed treatment opportunities.
Enhances Teamwork: The protocol provides clear roles and responsibilities for everyone involved, from the bystander who calls 911 to the specialized stroke team at the hospital.
Better Patient Outcomes: By ensuring rapid and appropriate care, the algorithm significantly improves a patient’s chances of survival and reduces the likelihood of long-term disability.

Learn How to Respond with Confidence

Knowing the signs of a stroke and the basic steps of the suspected stroke algorithm can empower you to save a life. At Safety Training Seminars, we believe that everyone should be equipped with life-saving skills. Our courses, like Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), cover stroke recognition and management in detail.

Our training is aligned with the latest American Heart Association guidelines, ensuring you receive the most current and effective education. With over 70 locations throughout California and a flexible blend of online learning and in-person skills sessions, getting certified has never been more convenient. We provide a supportive environment where you can learn and practice these critical skills. If you’re ready to build your confidence and be prepared for an emergency, we encourage you to book a course with us today.