Overlapping Processes
This is the organization that primarily accredits stroke centers in the United States.
What is the Joint Commission?
The classic presentation of ACS often involves chest pain described as this sensation.
What is pressure, tightness, or squeezing?
This is the maximum time, in minutes, from Rapid Response Chest Pain to obtaining and interpreting a 12-lead EKG for a chest pain patient.
What is 10 minutes?
Accreditation demonstrates this to patients and the community, in both Cardiac and Stroke care.
What is quality of care?
This type of stroke is more common in individuals of African descent.
What is hemorrhagic stroke?
This is a key process for both stroke and chest pain patients upon arrival to the ED.
What is rapid triage?
This is the term for chest pain that occurs at rest, or with minimal exertion.
What is unstable angina?
This is the recommended time window, in minutes, for a stroke patient to receive a CT scan after arriving at the emergency department.
What is 20 minutes?
Accreditation can lead to this, due to improved patient outcomes and efficiency, in both disease states.
What is improved financial performance?
This is the first imaging test that should be performed on a suspected stroke patient upon arrival in the emergency department.
What is a non-contrast CT scan of the head?
This organization is a primary accreditor for chest pain centers.
What is the American College of Cardiology (ACC)?
This atypical symptom of ACS, often mistaken for indigestion, can be a primary complaint.
What is epigastric pain or nausea?
If a hospital protocol were to utilize TNK for stroke thrombolysis, within what time window, in hours, from symptom onset would it ideally be administered? And what is one advantage TNK has over tPA in administration?
What is within 4.5 hours (or the current standard, depending on guidelines), and TNK is administered as a single bolus.
Accreditation helps ensure this for all patients, regardless of their presentation, for both stroke and cardiac patients.
What is standardized care?
While the acronym FAST is widely known, BE FAST adds two critical signs. What do the "B" and "E" in BE FAST stand for, and why are they important in recognizing a potential stroke?
What are Balance and Eyes, and they are important because they indicate potential brainstem or cerebellar involvement, which can be easily missed with just the FAST acronym?
Explain the shared importance of EMS pre-notification for both stroke and chest pain patients, and give one specific benefit that pre-notification provides to the receiving hospital for each type of patient.
What is: EMS pre-notification allows the hospital to activate specialized teams and prepare resources for both stroke and chest pain patients, leading to faster treatment. For stroke patients, it allows for faster CT scan preparation and potential tPA/thrombectomy team activation. For chest pain patients, it allows for quicker ECG acquisition and potential cardiac catheterization lab activation?
This demographic group is more likely to present with atypical ACS symptoms, such as shortness of breath or fatigue.
What are women, elderly patients, or diabetic patients?
This is the time window for endovascular thrombectomy in eligible stroke patients.
What is within 24 hours of last known well?
Accreditation promotes this among the multidisciplinary team across all disease states.
What is collaboration?
A rapid neurological assessment, using this standardized tool, helps determine the severity of a stroke and guides treatment decisions within the hospital.
What is the National Institutes of Health Stroke Scale (NIHSS)?
Describe how a hospital can leverage overlapping processes and resources between a stroke center and a chest pain center to improve overall patient outcomes and streamline accreditation efforts.
Shared multidisciplinary teams, standardized rapid triage, integrated data collection, shared quality improvement initiatives, and unified staff training.
This is the name of the risk score used to predict outcomes in patients with non-ST-elevation acute coronary syndromes.
What is the GRACE or TIMI risk score?
For a STEMI patient, this is the ideal time frame, in minutes, from arrival to the cardiac catheterization lab to the inflation of the angioplasty balloon.
What is 90 minutes? (or 120 minutes for transfer patients)
Accreditation demonstrates a commitment to this, through continuous monitoring and improvement, for all patients.
What is quality improvement?
Describe the optimal administration protocol for Tenecteplase (TNK) in acute ischemic stroke, specifically addressing the importance of time windows and the clinical implications of deviating from them. Discuss the factors that influence the decision to administer TNK and the parameters that dictate the bolus dosage.