A hospital “code” is a standardized, urgent alert used to mobilize a specialized team and resources for a patient experiencing a life-threatening emergency. This system ensures a rapid, coordinated response that bypasses routine procedures, saving minutes that can determine recovery or permanent disability. Code Neuro is an emergency alert specifically designated for time-sensitive neurological events where immediate intervention is paramount to preserving brain function. When announced, this code activates a precise protocol designed to bring expert care and advanced diagnostic technology to the patient quickly, dramatically shortening the time from symptom recognition to definitive treatment.
Medical Emergencies That Trigger Code Neuro
The activation of a Code Neuro is primarily driven by the suspicion of an Acute Ischemic Stroke, which involves a blood clot blocking an artery in the brain. In this condition, the principle of “time is brain” governs all action, as an estimated two million brain cells die every minute that blood flow is restricted. This rapid loss of neurological function requires the response to begin within moments of symptom onset to maximize the patient’s chances of a positive outcome.
Another serious condition triggering this alert is an Intracranial Hemorrhage, commonly known as a hemorrhagic stroke, where a blood vessel ruptures and causes bleeding within the brain tissue. Although less frequent than ischemic stroke, this event is associated with higher rates of disability and death. It necessitates an immediate response to control bleeding and manage rapidly increasing pressure inside the skull.
The Code Neuro protocol may also be activated for other severe neurological crises, such as Status Epilepticus, defined as prolonged or continuous seizure activity lasting more than five minutes. Uncontrolled seizure activity can lead to permanent neuronal damage if not stopped quickly. This makes it a time-sensitive emergency requiring a coordinated, rapid medical response.
The Coordinated Rapid Response Team
When a Code Neuro is called, an immediate rapid response team converges on the patient’s location, alerted simultaneously by the hospital’s communication system. The team includes an Emergency Department (ED) physician who directs the initial stabilization and triage. Specialized stroke-trained nurses perform focused neurological assessments, obtain intravenous access, and manage the patient’s airway and vital signs.
A neurologist is a core member of the response, often joining via a telemedicine link to provide expert consultation and assessment at the bedside. This tele-neurology approach allows remote expertise to be available 24 hours a day, which is useful in hospitals without an in-house neurologist. Imaging technicians and a radiologist are also notified immediately, preparing equipment and clearing the path to the Computed Tomography (CT) suite to avoid delay in obtaining diagnostic images.
Time-Critical Diagnostic Procedures
The initial step in the Code Neuro protocol is the immediate acquisition of brain imaging, typically a non-contrast CT scan, which must be completed within 25 minutes of the patient’s arrival at the ED. This scan is performed to rule out an intracranial hemorrhage. If bleeding is present, the patient cannot receive clot-busting medications, shifting treatment toward managing blood pressure and consulting neurosurgery.
If the CT scan shows no evidence of bleeding, the patient is presumed to have an ischemic stroke, and the focus shifts to confirming eligibility for time-sensitive treatments. A thorough history is gathered to determine the Last Known Normal (LKN) time—the moment the patient was last observed without stroke symptoms. This LKN time is essential because the effectiveness and safety of clot-dissolving drugs are strictly limited to a narrow treatment window, usually within three to four and a half hours of symptom onset.
The speed of the diagnostic process is measured by the “door-to-needle time,” the interval from the patient’s arrival to the start of intravenous thrombolytic drug administration. The nationally recognized benchmark for this metric is 60 minutes or less. Further imaging, such as a CT angiogram, may be performed to identify a large vessel occlusion, indicating the patient may benefit from a mechanical clot removal procedure.
Immediate Therapeutic Interventions
Once diagnostic imaging confirms an Acute Ischemic Stroke and the patient meets all treatment criteria, therapeutic intervention begins immediately. The first-line treatment for eligible patients is the intravenous administration of a thrombolytic agent, such as tissue plasminogen activator (tPA) or Tenecteplase. This medication must be given within the specified window from the LKN time.
For patients found to have a large vessel occlusion, preparations are made for a mechanical thrombectomy. This endovascular procedure involves a specialist threading a catheter through an artery to physically retrieve the clot from the brain, which can be performed up to 24 hours after symptom onset in select cases. Conversely, if the initial imaging reveals an Intracranial Hemorrhage, treatment focuses on tight control of blood pressure using intravenous medications to prevent further bleeding. The neurosurgery team is consulted immediately to evaluate for surgical intervention, which may be required to evacuate the blood clot and relieve pressure on the brain.