Show:
Code Stroke
Clinical Care
Core Measures
Quality Data
Teamwork
100
How is the stoke team activated?
44444
100
What are the warning signs of stroke?
FAST - explain
100
How many stroke core measures are there? Name three.
Eight. Three of the eight.
100
Do you get quality data on a regular basis?
Yes, monthly
100
When is the patient assessed for rehab?
Within 24 hours.
200
Where are the stroke protocols located?
On InSite under the campus information.
200
What five things are included in a neuro check?
Pupils, sensory, motor, speech, and GCS, which includes the LOC.
200
When a stroke patient with atrial fib is ready for discharge, what are 2 contraindications for anti-coagulation therapy?
Frequent falls, risk for bleeding, patient refusal
200
What do you need to work on?
May vary from different areas,
200
When can a stroke patient have food?
After a dysphasia screening result is negative and you get a doctor's order.
300
What kind of training have you received that qualifies you to care for a stroke patient?
This class, PIL modules - be specific
300
What is the blood pressure goal for hemorrhagic BP? What is the goal for SAH?
Systolic <160, MAP >60. MAP 70 - 100.
300
What is another medication to expect to order at discharge, and what specifics are considered to do so?
Ischemic stroke patients with LDL > 100 mg/dL, or LDL not measured, or, who were on a lipid‐lowering medication prior to hospital arrival are prescribed Statin medication at hospital discharge or document a contraindication to Statin medication.
300
Describe a PI process that you have worked on the past year.
May vary among different areas.
300
Who can administer tPA?
The stroke or ED physician, or a nurse that has been deemed competent to do so.
400
What is the cut-off time from onset of symptoms to call a code stroke versus a stroke consult?
Up to 12 hours after symptoms a code stroke is called. After 12 hours a stoke consult should be made.
400
What is the timeframe to administer tPA?
Up to 4.5 hours after the onset of symptoms
400
Name three complications for thrombolytic therapy
Active internal bleeding (<22 days) CT findings (ICH, SAH, or major infarct signs) History of intracranial hemorrhage or brain aneurysm or vascular malformation or brain tumor Platelets <100,000, PTT> 40 sec after heparin use, or PT > 15 or INR > 1.7, or known bleeding diathesis Recent intracranial or spinal surgery, head trauma, or stroke (<3 mo.) Recent surgery/trauma (<15 days) SBP > 185 or DBP > 110 mmHg despite treatment Seizure at onset Suspicion of subarachnoid hemorrhage
400
What are the goals for door to MD? Door to drug?
10 minutes. 60 minutes.
400
If a stroke patient is in the ED and needs an IR procedure, what action should be taken with the tPA being administered?
The administration should be continued with monitoring as required, and good handoff information given to the credentialed provider or nurse that has been deemed competent in tPA administration.
500
Who is considered the Primary Stroke Team?
Stroke fellow/attending and the research coordinator/nurse
500
How frequently are VS and neuro checks monitored during tPA administration? How is tPA given?
Every 15 minutes x 2 hours, every 30 minutes x 6 hours, then every 1 hour x 24 hours. 0.9 mg/kg (max 90 mg), 10% of dose given as a bolus over 1 -2 minutes, the remaining 90 % infused over 1 hour.
500
Name the five areas that must be addressed for stroke education?
Follow up care for discharge, home medications, stroke risk factors, signs and symptoms of stroke, activation of the EMS system (911)
500
What is the goal for door to CT completion? Door to CT read and report?
25 minutes. 45 minutes
500
What information do you provide to the caregiver when transferring the stroke patient to the next level of care and how is this done?
Onset of symptoms, physicians, medications, procedures, etc., as well as the system and neuro assessment TOGETHER with the receiving caregiver.