6.3 Acute Stroke Recognition and Routing
Key Takeaways
- Stroke care is time-sensitive: recognize signs, determine last known well, and activate the stroke system.
- Prehospital notification and rapid transport to an appropriate stroke-capable facility matter.
- Glucose check is important because hypoglycemia can mimic stroke.
- Blood pressure, anticoagulant use, imaging, and timing affect reperfusion decisions.
6.3 Acute Stroke Recognition and Routing
Stroke questions test early recognition and routing more than detailed neurology. Candidates should identify stroke signs, establish time last known well, check glucose, notify the receiving facility, and avoid delays.
Current official baseline
AHA ACLS course activity materials describe ACLS as training for professionals managing cardiac arrest, stroke, and cardiopulmonary emergencies, with completion requiring skills tests and at least 84 percent on the exam. Use the official AHA ACLS course activity information page when your course materials or training-center instructions differ from third-party summaries: AHA ACLS course activity information.
What you need to know
| Decision point | What to do |
|---|---|
| Recognition | Use facial droop, arm drift, speech abnormality, severe headache, vision changes, ataxia, or sudden neurologic deficit to suspect stroke. |
| Time | Last known well is not the time found. It is the last time the patient was known to be neurologically normal. |
| Mimics | Check glucose and consider seizure, migraine, intoxication, or other mimics while not delaying stroke activation. |
| Destination | Stroke systems depend on local routing, imaging, thrombolysis, and thrombectomy capability. |
How this shows up on BLS/ACLS questions
BLS and ACLS items usually test priority. Read the patient state first: age, pulse status, breathing status, rhythm, stability, and number of rescuers. Then choose the action that protects perfusion, oxygenation, defibrillation timing, or the correct algorithm branch. If an answer sounds advanced but delays CPR, shock delivery, ventilation, or an urgent stability intervention, it is usually a distractor.
Scenario anchor
A patient wakes at 7 AM with right-sided weakness. Last known well was 10 PM before sleep, not 7 AM. That timing affects reperfusion eligibility and destination decisions.
Common traps
- Using symptom discovery time as last known well.
- Forgetting glucose in altered mental status.
- Waiting for symptoms to improve before activating stroke response.
Study action
Write this section as a one-line rule in your own words, then test it with mixed questions from the BLS/ACLS practice bank. Do not review only the matching topic. Mix it with nearby branches so you can tell when the rule applies and when it does not. For example, compare respiratory arrest with a pulse against pulseless arrest, or compare unstable tachycardia against VF/pVT arrest. The exam rewards that discrimination more than memorizing isolated facts.
A stroke patient develops a "thunderclap headache" — sudden onset, worst headache of life. This presentation is MOST consistent with:
A patient has a witnessed ischemic stroke at 10:00 AM. After CT confirms no hemorrhage, tPA is given at 10:58 AM. According to AHA guidelines, the door-to-needle time was: