Hemorrhagic Stroke-ED
SBP < 140mmHg and DBP < 90 mmHg
What is the goal BP in patient with hemorrhagic stroke?
3 ounces
What is the amount of water that is swallowed for a dysphagia screening?
This is the scale used to measure the patient's signs/symptoms of stroke.
What is the NIHSS?
< 5 minutes
What is the goal door to provider exam time?
This core measure includes the use of chemical prophylaxis such as Lovenox, Heparin and Eliquis and mechanical prophylaxis such as SCD's for stroke patients who are admitted.
What is VTE Prophylaxis? STK 1
NPO
What is the diet are all hemorrhagic stroke patients ordered while in the ED?
Yale Swallow Protocol
What is the name of the dysphagia screening used at Geisinger?
This part of the NIHSS tests the patient's peripheral vision.
What is visual field testing?
< 30 minutes
What is the goal door to thrombolytic time?
This core measure is provided at discharge for pts with ischemic stroke and TIA patients unless contraindicated. Trials have shown even in patients with normal lipid profiles, this medication reduces the risk of cardiovascular events or even recurrent strokes.
What is discharge on a statin? STK 6
At least hourly and more often as the patient's condition warrants.
How often neuro checks are completed/documented in the first 24 hours?
The medical term for the symptom of difficulty swallowing.
What is dysphagia?
This part of the NIHSS scores for ataxia.
What is having the patient perform finger to nose and heel to shin testing?
< 10 minutes
What is the goal door to CT start time?
This STK core measure has been shown to reduce morbidity, mortality and recurrent strokes in patients when ordered at discharge.
What is STK 2 discharge on Antithrombotic?
30 degrees
What is the recommended elevation of HOB for hemorrhagic stroke patients?
Before anything PO in ANY patient presenting with Altered Mental Status and c/o stroke or stroke-like symptoms even if resolved.
What is when an RN should complete a dysphagia screening?
On arrival to the hospital, prior to TNK, post TNK, with any significant neurological change, with any nurse change and at least daily.
What is when a NIHSS should be completed?
< 20 minutes
What is the goal door to CT result time?
Patients discharged on these medications have been shown to reduce stroke reoccurrences in patients with afib/aflutter.
What are anticoagulants?
Systolic BP > 160mmHg, DBP > 90mmHg
What are the notification parameter for systolic BP in patient with hemorrhagic stroke?
A patient completes an uninterrupted drinking of all 3-oz of water without overt signs of aspiration.
What is a PASSing of the dysphagia screening?
The side of the lesion. (Stroke, tumor, bleed, etc)
What is the side a patient's gaze preference will look towards?
< 90 minutes
What is the goal door to transfer out time for a patient with a large vessel occlusion?
The inpatient staff is the key facilitator of this core measure. It is completed daily to improve knowledge about strokes, patients risk factors, and when to seek medical attention.
What is Stroke Education? STK 8