Ischemic Stroke
What is the post thrombolytic timeframe frequency for vitals and neuro checks?
Q 15 mins x 2 hrs, Q 30 mins x 6 hrs, Q 1 hr x 16
What is the BP parameters for an ICH?
What is the BP parameters for an SAH?
120-160 systolic= ICH
100-160 systolic= SAH
What types of CT's will a patient receive if their LKW is < 6 hrs vs >6 hrs and < 24hrs
Under 6 hrs= Dry CT and a CTA
Over 6 hrs Dry CT, CTA, CT perfusion
How would you define a stroke?
Who can call at BAT for a stroke Alert?
Anyone can call a BAT
What tasks do nursing need to do just before administrating of thrombolytics to make sure everyone is on the same page?
What is a time out- Use dot phrase
What are some advanced interventions UMMC can preform on a hemorrhagic stroke patient?
EVD, ICP monitoring, hemicraniectomy, clot evacuation
A patient is a TNK candidate, what should be done when returning to the room.
Weights- Documented weight in EPIC- Process may be changing- Future-weight in CT
What does BEFAST stand for
B-Balance
E- Eyes
F=Face
A- Arm
S- Speech
T= Time to call 911
What are some signs your patient is having a posterior circulation stroke?
Hemorrhagic transformation/ Angioedema
What drug would you except to be used to maintain a BP in range
Clevedipine- 1st choice
Cardene- 2nd choice
What size IV and location is needed for BAT CT
20g above the wrist
Patient received TNK and at first check the patient is now altered and obtunded. What is your first action
Who mixes Tenecteplase?
What is the timeframe for TNK?
What is the timeframe for Endovascular mechanical thrombectomy?
4.5 hrs
24 hrs
PCC, Kcentra
What piece of equipment should be in the hallway for all BATS in case it is needed for IV access
US machine
What makes UMMC a comprehensive Stroke center?
24/7 NSG, NIR, Vascular, able to preform advanced interventions
How many stroke credits do you need a year? How does UMMC allow you to obtain those credits?
UMMC ED =5
Offer a range of in person and virtual options
Name 3 absolute contraindications for TNK (thrombolytics)
ICH, recent DOAC usage, Platelets < 100K, INR > 1.7 BP over 185/110
What assessment findings could be a clue someone is having a hemmorgahic stroke
Blown pupil, N/V, HTN, Cushing's triad
When should CT be called for BAT patients? Who calls?
If by EMS as soon as the "box" goes off and upon arrival.
Charge nurse of desingee
Where would you find Stroke CPGs?
BAT BOX/ Intranet page
Titrate no more than 2 mg every 2 mins with goal of 140-180