Clot happens
What is our Stroke Alert Criteria in the ED?
BEFAST!
B-Balance
E-Eyes
F- Face
A- Arm
S- Speech
T- time-- less than 4.5 hours from the last known well or waking up
True or False: Your patient is neuro intact, with no focal deficits and their Head CT, shows a new intracranial hemorrhage. Since you know they are neuro intact, you know longer need to complete any neuro assessments
FALSE! This patient has a confirmed ICH, they should be getting Q15 VS x 1 hour, and Q15 neuro Assessements x 1 hour
Where within the Narrator can you document Ischemic Strokes and Hemorrhagic strokes?
Stroke Narrator!!
Your patient has a new ICH (confirmed on CT), their blood pressure is 198/110, you have given two pushes of labetalol (10mg x2), and the blood pressure come down to 185/105, what medication gtt should be started
Nicardipine
True or False. You need an IV prior to going to CT for a stroke alert
FALSE! Go to CT, get the CTH, then an IV can be obtained.
Your patient in the scanner is discovered to have a large ICH. What assessments should you begin and what is the timing of these assessments?
Vital signs and Neuro check Q 15 minutes for 1 hour.(utilize your stroke narrator!)
Where can you find your Bright yellow stroke sheets
On the document poles in each Zone.
A patient arrives with a blood glucose of 32 mg/dL and stroke-like symptoms. Should this be addressed prior to TNK?
YES! hypoglycemia can be a mimic for stroke
Your patient receives TNK after their CTH had no evidence of bleed, there was no Large vessel occlusion so no IR. What assessments are important for you to do now?
NIHSS and VS, Q15min x 2 hours, then Q30 x 5 hours, and then Q1x 16hours
What are the initial blood pressure goals for someone with a hemorrhagic stroke?
130-150
This screen should be performed on ALL suspected and confirmed TIA/Stroke/Hemorrhagic patients prior to anything PO.
Swallow Screen
your patient received TNK. Prior to TNK your patient had a NIHSS of 5, 30 minutes late, the patients NIHSS is now 10. should you:
a. Wait until the next NIHSS check to see if there is an improvement
b. all good, stroke patients fluctuate
c. notify Neurology stat
c. Notify neurology stat!
This blood pressure must generally be achieved before thrombolytic administration
less than 180/105
In hemorrhagic stroke patients the Head of bed should typically be elevated to this degree unless contraindicated
30 degrees
This is the most common cause (risk factor) of hemorrhagic stroke, and ER nurses spend half their shift fighting it
Uncontrolled Hypertension
IR for thrombectomy!
A patient comes into the ED with Right arm weakness, and slurred speech, they say the last time they were normal was 10 hours ago. Is this patient VAN positive or Negative?
VAN negative.
For your new hemorrhagic stroke patient, Choose one to delegate, one to address, and one come back to.
1. Blood Pressure is 205/100
2. Keppra ordered for Antiseizure prophylaxis
3. Coags ordered and need to be drawn
A. 1) Blood pressure- address
2) Delegate someone to draw coags
3) come back to keppra once BP is under control-- if the patient is not having active seizures, this does not need be a priority
Tight blood pressure control is critical to prevent this complication in our hemorrhagic stroke patients
hematoma expansion or increased bleed
Worsening headache, vomiting, and declining LOC may indicate this emergency complication in your ICH patient.
increased intracranial pressure or herniation