Stroke Pilot

Vitals on Arrival

Glucose

mmol/L

SpO₂

Temp

°C

Blood Pressure

/ mmHg

bpm

/min

Patient Details

Age (years)

Weight (kg)

Sex

♂ Male

♀ Female

Handedness

Right

Left

History of Presenting Illness

Other Information

Comorbidities

Stroke Risk Factors

⏱ Clinical Timeline

📟Code Activation

🚪Door / Arrival

🩺Neurologist Arrived Bedside

🕐Last Known Well

📋CT Requested

✅CT Completed

⚡Decision to Treat

💉tPA / Thrombolysis Given

Not given — administer in Plan

🧲Thrombectomy Requested

🚑Shifted to Cath Lab

🩸Groin Puncture (EVT)

🔓Reperfusion Achieved

🛏️ICU Bed Booked

Treatment Windows

--:--

set last known well above

Door-to-needle target <60 min · Door-to-groin target <90 min · ~1.9 million neurons lost per minute in untreated LVO.

NIH Stroke Scale. Score what you see — do not coach the patient. Use + Add NIHSS below to record serial scores (post-tPA, post-thrombectomy, 24 h…).

Baseline NIHSS

0/ 42

—

Select items

IV thrombolysis screen (alteplase / tenecteplase), per AHA/ASA criteria. Confirm the inclusion criteria, then check any contraindication that applies. Decision aid only — treating physician decides.

Extended window: 4.5–9 h or wake-up lysis may be reasonable with salvageable tissue on perfusion / DWI–FLAIR mismatch (2026 AHA/ASA). Screen LVO for EVT regardless of lysis eligibility.

✓

—

Answer the screen

Weight-based thrombolytic dosing. Enter actual body weight.

Patient weight (kg)

Alteplase (rt-PA) · 0.9 mg/kg

Total (max 90)—

Bolus · 10% over 1 min—

Infusion · 90% over 60 min—

Tenecteplase (TNK) · 0.25 mg/kg

Single IV bolus (max 25)—

Confirm BP <185/110 before bolus; maintain <180/105 for 24 h. TNK 0.25 mg/kg is a Class 1 alternative within 4.5 h (2026 AHA/ASA), preferred when EVT is planned. Verify against institutional protocol & pharmacy.

Secondary stroke calculators — all scores feed into the patient summary.

Glasgow Coma Scale —

Conscious level · E + V + M · /15

▾

ABCD² Score —

Early stroke risk after TIA · max 7

▾

CHA₂DS₂-VASc —

Stroke risk in AF · guides OAC · max 9

▾

HAS-BLED —

Bleeding risk on anticoagulation · max 9

▾

ICH Score —

30-day mortality in spontaneous ICH · max 6

▾

Hunt & Hess —

SAH clinical severity / surgical risk

▾

Modified Fisher —

CT blood burden — vasospasm risk after SAH

▾

Modified Rankin Scale — global disability/dependence. Use for baseline and outcome documentation.

—/ 6

—

Select level

Select all present findings. The engine scores weighted anatomical vectors across the neuraxis — cortex, deep grey, brainstem levels, cord, and PNS — and returns ranked localisations with differentials.

Side of body / limb deficit

Right

Left

Bilateral

None

Side of cranial nerve / face deficit — if this crosses the body side, the lesion is in the brainstem

Right

Left

Bilateral

None

Select findings to localize

Select the status of each modality. Tap Abnormal to reveal quick-tag chips and a free-text field. All findings feed automatically into the patient summary.

CT Brain — Non-contrast

✓ Normal

⚠ Abnormal

⏳ Pending

— Not Done

ASP

ASPECTS — Early CT Ischaemic Score

Tap each MCA-territory region showing early ischaemic change (hypoattenuation / loss of grey–white differentiation) on the non-contrast CT. Starts at 10; subtract 1 per affected region.

10/ 10

High

Tap regions with early ischaemic change

Ganglionic level (basal ganglia)

CCaudate

LLentiform nucleus

ICInternal capsule

IInsular ribbon

M1Anterior MCA cortex

M2MCA cortex lateral to insula

M3Posterior MCA cortex

Supraganglionic level (above basal ganglia)

M4Anterior MCA (superior)

M5Lateral MCA (superior)

M6Posterior MCA (superior)

ASPECTS ≥6 has historically defined EVT eligibility; recent trials (SELECT2, ANGEL-ASPECT, 2023) show benefit in selected large-core (low ASPECTS) patients. Score on the non-contrast CT before reviewing contrast studies.

CTA

CT Angiography

✓ Normal

⚠ Abnormal

⏳ Pending

— Not Done

CTP

CT Perfusion

✓ Normal

⚠ Abnormal

⏳ Pending

— Not Done

MRI

MRI Brain

✓ Normal

⚠ Abnormal

⏳ Pending

— Not Done

MRA

MR Angiography

✓ Normal

⚠ Abnormal

⏳ Pending

— Not Done

Start with the Acute Stroke Admission Orders — the universal bundle for every patient (monitoring, NPO/swallow, BP, glucose, fever, VTE, statin, ECG, bloods). The pathway sets below (Post-tPA, Post-EVT, DAPT, Anticoagulation, Cardiac, Young/Vasculitis…) list only what is unique to that pathway — no repeated lines. Tick orders or use Select All; every ticked order appears verbatim in the patient note. Disposition and target mRS at the bottom.

⚡ Acute Actions

🧩 TOAST Aetiology Classification

🩸

Large Artery

Atherosclerosis ≥50% stenosis ICA/MCA/BA

🫀

Cardioembolic

AF, valvular, LV thrombus, high/medium risk source

🔵

Small Vessel

Lacunar — deep infarct <1.5 cm, no cortical signs

🔬

Other Determined

Dissection, vasculitis, hypercoagulable, CADASIL

❓

Cryptogenic

Undetermined — incomplete workup or two competing causes

🔍

ESUS

Embolic stroke of undetermined source

💊 Antiplatelet Therapy

Tap a drug to expand dose options. Chosen dose appears verbatim in patient summary.

Aspirin (Acetylsalicylic Acid)

Clopidogrel (Plavix)

Ticagrelor (Brilinta)

Dipyridamole ER + Aspirin (Aggrenox)

Other / Combination

📍 Disposition

🎯 Target mRS at Discharge

Neurovascular evidence base — current society guidelines, the practice-defining randomised trials, and the primary source for every score, scale and screen built into this tool. Weighted to 2026 and recent years.

Verify before use. Compiled with AI assistance and not checked against a live citation database. Confirm every reference, volume, page range and DOI against the source of record before clinical or academic use.

Current guidelines

2026

Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the AHA/ASA. Stroke. 2026. Published online 26 Jan 2026.

doi: 10.1161/STR.0000000000000513

Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the AHA/ASA. Stroke. 2022;53(7):e282–e361.

doi: 10.1161/STR.0000000000000407

Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the AHA/ASA. Stroke. 2023;54(7):e314–e370.

doi: 10.1161/STR.0000000000000436

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the AHA/ASA. Stroke. 2021;52(7):e364–e467.

doi: 10.1161/STR.0000000000000375

Bushnell C, Kernan WN, Sharrief AZ, et al. 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the AHA/ASA. Stroke. 2024;55(12):e344–e424.

doi: 10.1161/STR.0000000000000475

ESO

Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):I–LXII.

doi: 10.1177/2396987321989865

Reperfusion — intravenous thrombolysis

AcT

Menon BK, Buck BH, Singh N, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, randomised, non-inferiority trial. Lancet. 2022;400(10347):161–169.

doi: 10.1016/S0140-6736(22)01054-6

TRACE-2

Wang Y, Li S, Pan Y, et al. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3 randomised non-inferiority trial. Lancet. 2023;401(10377):645–654.

doi: 10.1016/S0140-6736(22)02600-9

TIMELESS

Albers GW, Jumaa M, Purdon B, et al. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. N Engl J Med. 2024;390(8):701–711.

doi: 10.1056/NEJMoa2310392

BRIDGE-TNK

Qiu Z, Li F, Sang H, et al. Intravenous Tenecteplase before Thrombectomy in Stroke. N Engl J Med. 2025;393(2):139–150.

doi: 10.1056/NEJMoa2503867

WAKE-UP

Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med. 2018;379(7):611–622.

doi: 10.1056/NEJMoa1804355

EXTEND

Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med. 2019;380(19):1795–1803.

doi: 10.1056/NEJMoa1813046

Reperfusion — endovascular thrombectomy

DAWN

Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11–21.

doi: 10.1056/NEJMoa1706442

DEFUSE 3

Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708–718.

doi: 10.1056/NEJMoa1713973

SELECT2

Sarraj A, Hassan AE, Abraham MG, et al. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med. 2023;388(14):1259–1271.

doi: 10.1056/NEJMoa2214403

ANGEL-ASPECT

Huo X, Ma G, Tong X, et al. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med. 2023;388(14):1272–1283.

doi: 10.1056/NEJMoa2213379

TENSION

Bendszus M, Fiehler J, Subtil F, et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): randomised trial. Lancet. 2023;402(10414):1753–1763.

doi: 10.1016/S0140-6736(23)02032-9

LASTE

Costalat V, Jovin TG, Albucher JF, et al. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size. N Engl J Med. 2024;390(18):1677–1689.

doi: 10.1056/NEJMoa2314063

ATTENTION

Tao C, Nogueira RG, Zhu Y, et al. Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med. 2022;387(15):1361–1372.

doi: 10.1056/NEJMoa2206317

BAOCHE

Jovin TG, Li C, Wu D, et al. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2022;387(15):1373–1384.

doi: 10.1056/NEJMoa2207576

mTICI

Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650–2663.

doi: 10.1161/STROKEAHA.113.001972

Intracerebral haemorrhage

INTERACT3

Ma L, Hu X, Song L, et al. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): stepped-wedge cluster RCT. Lancet. 2023;402(10395):27–40.

doi: 10.1016/S0140-6736(23)00806-1

ANNEXA-I

Connolly SJ, Sharma M, Cohen AT, et al. Andexanet for Factor Xa Inhibitor-Associated Acute Intracerebral Hemorrhage. N Engl J Med. 2024;390(19):1745–1755.

doi: 10.1056/NEJMoa2313040

ENRICH

Pradilla G, Ratcliff JJ, Hall AJ, et al. Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage. N Engl J Med. 2024;390(14):1277–1289.

doi: 10.1056/NEJMoa2308440

Secondary prevention — antiplatelet therapy

CHANCE

Wang Y, Wang Y, Zhao X, et al. Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack. N Engl J Med. 2013;369(1):11–19.

doi: 10.1056/NEJMoa1215340

POINT

Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med. 2018;379(3):215–225.

doi: 10.1056/NEJMoa1800410

THALES

Johnston SC, Amarenco P, Denison H, et al. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med. 2020;383(3):207–217.

doi: 10.1056/NEJMoa1916870

CHANCE-2

Wang Y, Meng X, Wang A, et al. Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA. N Engl J Med. 2021;385(27):2520–2530.

doi: 10.1056/NEJMoa2111749

Stroke severity & imaging scores

NIHSS

Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–870.

doi: 10.1161/01.STR.20.7.864

GCS

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;304(7872):81–84.

doi: 10.1016/S0140-6736(74)91639-0

ASPECTS

Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet. 2000;355(9216):1670–1674.

doi: 10.1016/S0140-6736(00)02237-6

ASPECTS

Pexman JHW, Barber PA, Hill MD, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol. 2001;22(8):1534–1542.

mRS

van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–607.

doi: 10.1161/01.STR.19.5.604

mRS

Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2(5):200–215.

doi: 10.1177/003693305700200504

Atrial fibrillation — stroke & bleeding risk

CHA₂DS₂-VASc

Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey. Chest. 2010;137(2):263–272.

doi: 10.1378/chest.09-1584

HAS-BLED

Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–1100.

doi: 10.1378/chest.10-0134

TIA risk & stroke aetiology

ABCD²

Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292.

doi: 10.1016/S0140-6736(07)60150-0

TOAST

Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial (TOAST). Stroke. 1993;24(1):35–41.

doi: 10.1161/01.STR.24.1.35

Haemorrhage grading scales

Hunt-Hess

Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20.

doi: 10.3171/jns.1968.28.1.0014

ICH score

Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–897.

doi: 10.1161/01.STR.32.4.891

mod. Fisher

Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale. Neurosurgery. 2006;59(1):21–27.

doi: 10.1227/01.NEU.0000218821.34014.1B

Dysphagia screening & diet

GUSS

Trapl M, Enderle P, Nowotny M, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke. 2007;38(11):2948–2952.

doi: 10.1161/STROKEAHA.107.483933

FOIS

Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–1520.

doi: 10.1016/j.apmr.2004.11.049

IDDSI

Cichero JAY, Lam P, Steele CM, et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids: the IDDSI Framework. Dysphagia. 2017;32(2):293–314.

doi: 10.1007/s00455-016-9758-y

Neuroanatomical localisation (reference texts)

Text

Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology. 7th ed. Philadelphia: Wolters Kluwer; 2016.

Text

Ropper AH, Samuels MA, Klein JP, Prasad S. Adams and Victor's Principles of Neurology. 11th ed. New York: McGraw-Hill; 2019.

Text

Campbell WW. DeJong's The Neurological Examination. 7th ed. Philadelphia: Wolters Kluwer; 2013.