# Stroke: recognition, treatment & routing

Capture last known well, check stroke-triage findings, treat reversible problems, and coordinate destination.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: Revised July 18, 2023 · Final implementation April 1, 2024.
Canonical page: https://www.ocmedic.com/guides/stroke/
Official source: [SO-M-025 — Suspected Acute Stroke or Intracranial Hemorrhage (Stroke Triage Criteria)](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-M-025%20Stroke%2010-2023.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Protect the airway & preserve the history

- No oral food or fluid; the source specifically permits dissolving ondansetron.
- Avoid IO/external-jugular access in a potential stroke-neurology destination patient because thrombolysis may create difficult-to-control bleeding. The source’s narrow IO dextrose exception is stated below.

## Source documents

- [SO-M-025 — Suspected Acute Stroke or Intracranial Hemorrhage (Stroke Triage Criteria)](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-M-025%20Stroke%2010-2023.pdf)

## Check the ischemic-stroke pathway

- All three: usual neurologic baseline within the past 24 hours; appropriate response to voice/visual cues or spontaneous eye opening; and new one-sided arm drift/paralysis, facial droop, or unequal grip.

## Check for possible intracranial bleeding

- Sudden, severe headache within 24 hours plus repeated vomiting, neurologic deficit, altered mental status, or diastolic BP above 100.
- If altered mental status prevents obtaining a history: unexplained repeated vomiting, neurologic deficit, diastolic BP above 100, or paramedic judgment of acute bleeding may meet criteria.

## Immediate checks & routing

1. Record last known well. Obtain a witness phone number when possible.
2. Contact base for patients meeting stroke-triage criteria and prepare for stroke-team activation.
3. Monitor rhythm and document a strip. If room-air SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min as tolerated.
4. Avoid oral food or fluids; the source permits dissolving ondansetron.
5. If criteria are not met, provide ALS transport to the nearest emergency receiving center.

## Glucose & nausea treatment

- Check blood glucose. SO-M-025 uses a value below 60 mg/dL: D10 250 mL IV, or glucagon 1 mg IM if IV access cannot be obtained.
- The IO dextrose exception is limited to an unconscious patient with glucose below 60, no IV access, and no response to IM glucagon.
- For nausea/vomiting when pregnancy is neither known nor suspected: ondansetron 8 mg ODT or 4 mg IV. The IV dose may be repeated after about 3 minutes if symptoms persist.

## Handoff essentials

- Document when the patient was last at their usual neurologic baseline, not just when the deficit was discovered. Obtain a witness callback number when possible.
- Report the observed deficit, glucose and response to treatment, level of consciousness, headache/vomiting findings, and BP. Coordinate the stroke destination through base.