Stroke 411
How many minutes do you have to activate a Brain Alert in the ED or Tier-1 when suspecting a patient with a new onset BEFAST symptom?
10 minutes
How do you administer Tenecteplase?
A single IV push bolus over five (5) seconds, preceded and followed by a 10 ml NS flush
List three (3) possible side effects of Thrombolytic therapy
1) Angioedema, 2) Headache, and 3)Bleeding (hemorrhagic conversion)
TnK was administered at 1000 hours. When should you start your V/S and Neuro assessment on the monitoring sheet?
1000 hours
What to do on a patient with an acute onset of BEFAST symptoms?
1) Activate Tier-1 by calling 323-279-1000
2) Notify Neuro Interventionalist
Every 10 minutes while in CT or MRI
What is the Gold Standard treatment of an acute Ischemic Stroke within 4.5 hours from LKWT and the presence of a large vessel occlusion?
Thrombolytic and Thrombectomy
Suggested blood pressure limit for s/p thrombolytic recipient undergoing endovascular therapy
Keep BP < 180/105
Procedure monitoring start time when hemostasis is achieved at 1500 hours
1500 hours
Within how many minutes should a time-out be documented before a procedure start time?
Following the Stroke Order Set
What is the treatment for an acute aneurysmal Subarachnoid Hemorrhage?
Endovascular coil embolization
Suggested blood pressure medications for s/p thrombolytic recipient undergoing endovascular therapy
IV Labetalol 10-20 mg
IV Clevidipine 1-2 mg/hr
1) GCS, 2) Simple Neuro, 3) Complex Neuro, 4) NIHSS
How many minutes are permitted from IR arrival to puncture time for an emergent thrombectomy?
What three (3) objectives does the Scientific Statement, FeSS, observes?
1) Fever, 2) Sugar (hyperglycemia), and 3) Swallowing (dysphagia)
What is the treatment for Delayed Cerebral Ischemia (i.e. cerebral vasospasm)?
Intra-arterial Verapamil
Nursing intervention if bleeding is encountered on an radial artery occlusive device (ie TR Band)
Re-inflate the balloon until bleeding stops
What are the four (4) components assessed and monitored on patients s/p Neuro IR procedures?
1. Vital Signs, 2. Acess site (radial or femoral), 3. Peripheral pulses, 4. Neurological (GCS, Complex, NIHSS)
Name of SmartPhrase documented on nursing notes required on all Neuro IR procedures
.PAMM SmartPhrase
What would the patient score on NIHSS' Item #7, Ataxia, if the patient scores a "4" on items 5b (right) and 6b (right)?
0
How do you administer Alteplase?
10% of the total treatment dose should be administered as an initial bolus over 1 minute.
The remaining treatment dose should be infused intravenously over 60 minutes.
Target BP range for acute Intracerebral Hemorrhage patients
SBP 130-150 mmHg
How often should you monitor the patient s/p Intra-Arterial Thrombolytic?
Vital signs q15 mins x1 hour, then 30 mins x1 hour, then q1h x22 hours.
Neuro q1h x24 hours.
Puncture site and peripheral pulses q15 mins x1 hour, then 30 mins x1 hour, then q1h x4 hours.
How many time-out documentation is required on an emergent thrombectomy case requiring general anesthesia?
At least two (2) times - before induction and procedure start time