›Immediate stabilization workflow
›Airway support if unable to protect
›Oxygen if SpO2 under 94 percent
›Cardiac monitor and defibrillator pads if unstable
›IV access
›Two large bore IV if hypotension or bleeding
›Point of care glucose
›ECG within 10 minutes
›Neuro checks frequency
›q15 minutes if concern for deterioration
›Immediate neuro escalation triggers
›New focal deficit
›Worsening mental status
›Severe headache progression
›Seizure recurrence
›Persistent vomiting with headache
›Initial testing
›ECG
›Glucose
›CBC and electrolytes if indicated
›Neuro pathway testing
›If persistent focal deficit, activate stroke pathway local protocol dependent
›If thunderclap headache, CT head urgent
›If anticoagulated with head strike, CT head urgent
›Cardiac and PE pathway testing
›If chest pain or dyspnea, troponin and chest imaging strategy
›If PE concern, use pretest probability tool and D dimer strategy local protocol dependent
Therapeutics and targeted management
›Hemodynamic support
›IV crystalloid bolus
›500 mL to 1000 mL in suspected volume depletion
›Reassess BP and symptoms after bolus
›Bradycardia management if unstable
›Atropine IV 1 mg
›Repeat every 3 to 5 minutes
›Maximum 3 mg
›Transcutaneous pacing if refractory
›Tachyarrhythmia management if unstable
›Synchronized cardioversion per ACLS
›Sedation if time permits
›Seizure management if active seizure
›Lorazepam IV 2 mg
›Repeat once after 5 minutes if ongoing
›Levetiracetam IV 60 mg per kg
›Maximum 4500 mg
›Headache and SAH pathway symptoms
›Analgesia choices avoiding hypotension
›Antiemetic options with QT caution
›Reassessment timing and targets
›Repeat vitals every 30 to 60 minutes until disposition
›Repeat neuro exam after imaging or symptom change
›Review telemetry for ectopy or pauses
›Orthostatic symptoms after fluids if applicable