Stroke Alerts
Time is ________?
Brain!
For a large vessel stroke/ occlusion, ~2 million neurons die every minute.
Every hour that passes during a stroke without treatment is equivalent to 3.6 years of normal aging.
Assessment performed during a stroke alert to determine disability and deficits.
What is the NIHSS
Q 15-minute vitals and neuro checks x 1 hour
The assessments which are done after finding a bleed on CT head. (ICH and SAH)
130-150 Systolic
BP goals for a SAH who arrives with a SBP > 150
Located at charge desk for stroke alerts.
RED stroke book for new and used brain boards and stroke information such as TNK administration.
Time goal for door to needle time for TNK
30 minutes!!
Faster treatment is associated with reduced hospital mortality, and increased chance of walking independently at discharge, discharging home versus subacute care, less risk of ICH, and decreased length of stay.
Cardene gtt!
Patients with extreme hypertension can be treated immediatly with a cardene drip to reduce BP for thromboytic treatment.
What information is on the back of the Brain Board.
This is where I can find all my documentation tips and trackers for Vitals and Neuro checks for an ICH.
The Goal from Door to BP Control.
< 60 minutes
Door to BP control goal to have BP < 140 by for all SAH patients.
Early reduction of blood pressure leads to better outcomes for SAH patients and can reduce bleed expansion and increased ICPs.
Yellow paper to track stroke alerts.
Brain Board!
Also can help track NIH and vitals post treatment AND track vitals and neuro checks for ICH and SAH.
Name 2 to 3 things that must be completed before thrombolytic treatment.
CT scan and BP check
Blood Sugar
NIHSS
BP < 180/105 and no blood on CT (non con).
Thrombolytic can be given in CT and before the CTA.
Generally, all other tests and assessments can be performed after the thrombolytic is given.
<180/105
Blood pressure goal pre and post stroke treatment with thrombolytics
Should be within goal in < 60 minutes from arrival.
Blood pressure.
Early reduction of blood pressure leads to better outcomes for ICH patients and can reduce hematoma expansion.
This is our blood pressure goal for SAH.
130-150 systolic
Black box near pharmacy that has stroke resources for RNs and patients.
BRAIN BOX!
Has extra brain boards, MRI screening forms, TNK and thrombectomy information for patients and more
This person is instrumental during a stroke alert.
THE ED RN!!!
You are helping to determine LKW, indications for treatment and moving the patient quickly towards treatment.
YOU are one of the main players in ensuring stroke patients are treated quickly from ED door to thrombolytic to IR.
Permissive hypertension
Technique that maintains higher blood pressure following a stroke IF they have not received thrombolytics.
Doctors typically reduce a person's hypertension medication for 24-48 hours after a stroke.
Maintaining high blood pressure after a stroke can help protect the brain.
130 - 150 Systolic
Blood pressure goal for a patient with an ICH
Almost _____ of people with a SAH die before getting to a hospital.
HALF.
AND nearly half of patients presenting with a SAH caused by an aneurysm die within 30 days.
1/3 of those who survive have complications.
Share Point Stroke Page
TNK/tPA/thrombectomy information, education opportunities and more!!
The GOAL of the stroke alert
To quickly determine if patient is having a disabling symptoms, assess for treatment contraindications and offer TNK and/or Thrombectomy.
Cardene can be titrated every ________ minute(s) to reduce BP for thrombolytic treatment.
5 - 15 minutes!
It is started at 5mg/hr. and titrated at a rate of 2.5mg/hr every 5-15 minutes with a max dose of 15mg/hr.
Accounts for a disproportionate amount of cerebrovascular mortality and morbidity.
ICH!
Most ICH will discharge from the hospital to LTC.
Can cause expansion of bleed and increased ICP.
Not controlling BP aggressively.
Where in EPIC to chart during a stroke alert.
Stroke Narrator!
Use it for all your needs! vitals, NIH, swallow screen and more! Can be used whether we treat a patient or not!