TYPES OF STROKES
A blockage in a blood vessel that prevents oxygen and nutrients from being delivered to a part of the brain, resulting in cerebral infarction
Acute Ischemic Stroke
Where to find Tufts specific stroke policies and guidelines?
Policytech (via EVA by searching for “stroke”"
Balance issues, vision changes, facial droop, arm weakness, speech difficulty
Symptoms of a stroke
Can be given up to 24 hours after last known well time at TMC
Tenectaplase
Tobacco use, illicit drug use, obesity, alcohol abuse, inactivity, poor diet.
Behavioral/lifestyle risk factors for AIS
Bleeding - specifically ICH, bleeding from other site, and orolingual angioedma.
complications of IV TPA
6-5555
What is the number to dial to call a stroke code?
Rupture of a blood vessel that causes bleeding into the brain tissue
Intracerebral hemorrhage/intraparenchymal hemorrhage
When should a dysphagia screen be completed?
On any new stroke patient before ANY oral intake (medications, liquids, or food)
Individualized education handout provided to the patient
Patient Passport
2 high intensity statin medications?
Atorvastatin and Rosuvastatin.
Risk factors for ICH/IPH?
Tobacco use, obesity, blood thinning meds, HTN, blood vessel abnormality, AV fistula, cerebral amyloid angiopathy.
Bacteria in oral secretions & dental plaque if aspirated can cause this
Pneumonia
A tool to help measure neuro function in pts who are suspected of having a stroke & assess the severity of stroke symptoms. Score 0-42.
NIHSS (National Institutes of Health Stroke Scale)
Rupture of a blood vessel that has caused bleeding on the surface of the brain
Subarachnoid Hemorrhage
Frequency of vital signs and neuro checks post tPA?
What are your stroke edu annual requirements?
Complete annual stroke symposium in person/online
What are some examples of antiplatelet medications?
Aspirin, Cilostazol, Clopidogrel (Plavix), Prasugrel (Effient).
What are some vascular risk factors for acute ischemic stroke?
HTN, HLD, CAD, HF, atherosclerosis, DM.
This post stroke complication can lead to worse outcomes & increased length of stay - symptoms include fever & mental status change
UTI
Narrowing of the cerebral arteries due to contraction of the smooth muscle within the arterial wall which can cause delated cerebral ischemia.
Vasospasm
What is an ESUS?
Embolic stroke of unknown source.
Every 15 minutes for 1 hour.
Every 30 minutes for 1 hour.
Every 60 minutes for 2 hours.
Then per protocol.
VS post EVT
Lifestyle modifications such as diet & exercise, as well as treatment with statin therapy.
What are some examples of anticoagulant medications?
Apixaban (Eliquis), Xarelto (Rivaroxaban), Warfarin (Coumadin)
A disease of the arteries characterized by a build-up of plaque and fatty materials on the inner walls of the arteries
atherosclerosis
Immobilization post stroke can cause
Skin breakdown, pain, contracture, joint damage related paretic pain
What is the goal LDL for patients with AIS and TIA?
<70 in patients with evidence of atherosclerotic disease. < 100 in patients without evidence of atherosclerotic disease.
Cryptogenic Stroke
Definite, extensive brain hypodensity on head CT representing the entirety of the vascular territory supplied by the occluded artery
Current intracranial hemorrhage thought to be the cause of the neurologic symptoms or deficits
Hemodynamic or respiratory instability likely to substantially increase the risk of periprocedural harm or mortality, and likely to not be easily stabilized at the present level of care
Exclusion Criteria for EVT
Why is it important to lower LDL in patients with AIS & TIA?
Atherosclerotic disease.
Lowering LDL will help to reduce the risk of primary & secondary stroke by preventing onset/progression of atherosclerotic disease.
A calcium channel blocker that helps to relax smooth muscle. This is prescribed as a 21 day course: 60mg given q4 hours or 30 mg q2 hours, for improved neurological outcomes in patients with SAH.
Nimodipine
HTN, blood thinning meds, aneurysms, tobacco use.
Risk factors for SAH
Head of bed should be set at what level for hemorrhagic strokes and what lecel for ischemic strokes?
30
15-30/possibly flat in certain cases
What are some quality improvement initiatives within the Comprehensive Stroke Center?
Stroke patient passports (patient education), reducing door to needle time for IV tPA, reducing length of stay for patients with dysphagia (using PRESS calc and discharge to rehab with NGT), improving post-intervention nurse monitoring compliance