STROKES
The most common type of stroke.
What is ischemic?
Trouble speaking, loss of balance or coordination, sudden numbness or weakness of face, arm, or leg, especially on one side of body.
What are common symptoms of stroke?
The time frame in which blood pressure should be controlled for an ICH or SAH.
What is 60 minutes.
Blood pressure control for ICH and SAH is a key intervention to limit rebleeding, hematoma expansion and associated morbidity.
NIHSS test item where patients describe what they see in a picture and name the items in a picture.
What is best language. We are testing for aphasia, commonly seen in a left hemisphere stroke. The patient loses the ability to use the correct language or understand language and may lose the ability to speak entirely.
Priority in care of the stroke patient with altered/decreased LOC.
What is maintaining the airway?
The percentage of patients who do not arrive in the ED in time for thrombolytic treatment.
(arrive > 4.5 hours from LKW)
What is 66%
Continued community education on stroke and stroke symptoms is crucial to improve the knowledge of stroke symptoms and to call 911.
Can be the cause of 'the worst headache of my life.'
What is a subarachnoid hemorrhage (SAH)?
Blood pressure of 130-150
What is the goal BP for an ICH and/or SAH.
Smooth and sustained blood pressure control is associated with improved patient outcomes.
What is best gaze.
This tests horizontal eye movement. Patients will look towards their stroke, and in severe cases will be unable to cross midline.
This screen should always be done on Stroke and TIA patients prior to any PO.
What is a swallow screen. If the patient fails, they must be evaluated formally by speech and kept NPO.
Stroke patients are at a very high risk of aspiration.
The type of ischemic stroke caused by a clot or plaque fragment that travels through the bloodstream to the brain.
What is embolic?
The sudden onset of trouble forming sentences, using correct language, or understanding commands/language.
What is aphasia?
Receptive: patient does not understand what is being said to them.
Expressive: Patient is unable to use correct language or speak at all. Can be very fragmented language.
Gtt that is utilized to control blood pressure in ICH and SAH's.
What is Nicardipine.
Can be started at 5mg and titrated by 2.5 mg increments every 5 to 15 minutes.
On the NIHSS this item can't be scored if you can't prove it. (If they are too weak, can they do this exam?)
What is Ataxia. If the patient is too weak in a limb to perform the ataxia exam, then you score a 0.
This assessment should be completed by the ED and NICU RN when a stroke patient is transferred from the ED to the ICU.
What is the dual assessment sign off.
Both IS and hemorrhagic strokes should have a dual sign off NIHSS (IS) or neuro assessment (Bleeds) completed when the patient is transferred to the ICU. The primary ED RN must transport the patient to the ICU.
Sudden onset nausea/vomiting, dizziness, brief loss of consciousness or a period of decreased consciousness.
What are some of the signs of a posterior stroke: Cerebellar and/or Basilar?
A BP < 185/110 is required for what kind of treatment for ischemic stroke.
What is for the administration of thrombolytics (TNK).
The only two questions you can score as 'UTA' on the NIHSS.
What is dysarthria if they are intubated and motor arm/leg if the patient has an amputation or joint fusion.
What is the MRI screening form. Forms can be found in the brain box outside of Room 5 in the ED.
If you cannot complete the MRI screening form - pan x-rays of the chest/ABD/Pelvis must be completed STAT.
The two most common causes of subarachnoid hemorrhagic.
What are head trauma and aneurysm?
Sudden onset of left gaze preference, language difficulty, right facial droop, right arm and leg weakness.
What is a Left Middle Cerebral Artery syndrome (L MCA).
Acute hypertension in an ICH or SAH can cause this.
What is hematoma expansion in ICH and SAH, leading to worse patient outcomes.
BP can be very high upon ED arrival in these patients.
The patient is ignoring their left side, and the left side of their environment, they are demonstrating this phenomenon.
What is extinction and inattention (formerly neglect)
Most common in right sided strokes, this causes the patient to ignore the left side of their body and environment. This is a perceptual disorder and they patient may be able to see and feel on the left but not acknowledge it.
Q15 min neuro checks and vitals x 1 hour.
What is the timing of the neuro assessments and vitals post bleed on a CT head. MD will place order set - can start these assessments as soon as you know there is blood on the head CT, you do not have to wait for the order.