Stroke Management: ACLS Certification Guide

Stroke Management
  • Updated on: May 4, 2024

Did you know that every 40 seconds, someone in the United States experiences a stroke? In the race against time, strokes claim lives every day. In the evolving domain of emergency medicine, it is crucial to ensure stroke management to improve patients’ recovery. Through ACLS certification, healthcare professionals travel through the difficult terrain of stroke care using the power of ACLS. The article analyzes the complexities of ACLS stroke algorithm and unfolds intricacies of stroke management. Learn how ACLS certification is not a credential but a linchpin in managing strokes.

What is a stroke protocol?

The stroke protocol forms a detailed roadmap for acute care aimed at providing well-coordinated help to patients suffering from stroke. It is a comprehensive approach that combines clinical assessment, advanced imaging procedures, and rehabilitative interventions to maximize results while minimizing the consequences of a cerebrovascular event.

Key Components of a Stroke Protocol: 

  1. Rapid Recognition and Assessment: Healthcare providers need to develop their skills in identifying the most prevalent stroke markers, i.e., facial droop, arm weakness, and speaking difficulty. Standardized assessment using the NIH Stroke Scale (NIHSS) allows for a thorough examination of neurologic deficits and quantification of stroke severity.
  2. Imaging Studies: Immediate non-contrast CT scans are critical in differentiating ischemic from hemorrhagic strokes and providing the necessary foundation for future therapy. In some instances, further assessment using advanced imaging modalities like magnetic resonance imaging (MRI) may be necessary.
  3. Thrombolytic Therapy: The administration of tissue plasminogen activator (tPA) is still one of the major pillars in acute ischemic stroke management.
  4. Endovascular Interventions: Mechanical thrombectomy via endovascular procedures is a core treatment for eligible patients with large vessel occlusions, contributing to the patient’s life. Timely completion of these procedures requires collaboration between internal radicals and neurosurgeons in this department.
  5. Multidisciplinary Collaboration: This helps ensure that the neurologist, emergency physician, radiologist, and nursing staff do everything in unison, hence an efficient way of handling acute stroke cases. Training and regular simulation exercises improve team communication as well as response times.

What are the 8 Ds of the ACLS stroke algorithm?

An experienced advanced cardiac life support (ACLS) provider follows a set of stages in diagnosing and treating an acute stroke, known as the 8 Ds of stroke in ACLS. These globally recognized steps give stroke patients quick and efficient care. including the symptoms leading to the diagnosis of stroke as well as discharge from the hospital after treatment. Learn the 8 Ds of stroke ACLS algorithm here:

  1. Detection: Such rapid recognition of stroke symptoms that include weakness on one side of the body, facial drooping, slurred speech, and arm drift.
  2. Dispatch: It entails the early activation of EMS.
  3. Delivery: Timely transport of a patient in an ambulance for emergency medicine services (EMS).
  4. Door: Critical from the point when they arrive at the hospital till the commencement of the treatment.
  5. Data: This entails speedy triage, assessment, and management of patients in the ED.
  6. Decision: In this stage, stroke expertise and therapy choices are critical for positive outcomes.
  7. Drug/Device: Fibrinolytic therapy or other medical devices are applicable in different strokes, depending on their nature and extent.
  8. Disposition: Finally, the medical practitioners will decide on further procedures for a patient’s case, and they may include a stroke center.

What are the major types of stroke ACLS?

Strokes constitute a critical health problem that calls for urgent care or treatment measures. In Advanced Cardiovascular Life Support (ACLS), there are two major types of stroke that healthcare professionals need to be aware of: 

 1. Ischemic Stroke: Among ACLS stroke protocol, it is the most prevalent type and causes some 87 percent of strokes. This occurs due to a blood clot that blocks or impedes the flow of blood to part of the brain, leading to cell death and subsequent neurological damage.

2. Hemorrhagic Stroke: It occurs less frequently and has a greater fatality rate. This happens when a blood vessel bursts, leading to blood leakage within or around the brain. Thereafter, high pressure is exerted on the brain, leading to the tearing of brain tissue.

What stroke screen does ACLS use?

ACLS uses the NIH Stroke Scale as the stroke screen. NIHSS is a fifteen-item screening procedure that establishes whether a stroke exists and how serious it is. It not only helps inform treatment options but also aids in prognostication.

What is the advantage of the stroke severity tool, ACLS?

Managing and providing treatment for cardiac arrest in ACLS stroke patients using a stroke severity scale helps improve the efficiency of ACLS. Such tools are very useful for healthcare professionals who make decisions based on evidence. Learn its advantages:

  1. Diagnostic Clarity: The NIHSS is a diagnostic procedure that enables the detection of a stroke. It can also distinguish between an ischemic stroke and a hemorrhagic stroke and thereby aid in determining necessary medical interventions.
  2. Severity and Prognosis Assessment: The stroke severity helps assess the severity. Apart from choosing treatment options, it helps predict both short-term and long-term outcomes, hence assisting in making accurate patient management decisions.
  3. Standardization of Care: With the use of a stroke severity instrument such as the NIHSS, the administration can have uniform methods of offering care to stroke patients. This provides the common terminology and criteria for stroke assessment, which facilitates communication among healthcare professionals and enhances the quality of stroke care delivery.
  4. Research and Quality Control: In clinical trials and other research studies, the NIHSS is generally considered a reliable parameter for rating stroke severity. Moreover, continuous monitoring of changes in the NIHSS scores will help to improve the quality and control of various hospitals and healthcare systems.


Stroke management is one of the essential topics in an ACLS certification course. A clinical aspect of stroke algorithm ACLS involves the use of the NIH Stroke Scale, a crucial tool in assisting medical practitioners with the tasks of finding, quantifying, and normalizing care, as well as controlling the standard for management intervention. It goes a long way toward improving patient outcomes. Stroke, still one of many causes of illness and death worldwide, proves the significance of stroke protocol ACLS as part of the postgraduate education of ACLS instructors. It is crucial for ongoing learning and practicing to offer excellent services to patients.