Stroke Risk Factors
This is the most common arrhythmia and can increase risk for stroke by 25%
What is Atrial Fibrillation
Numbness or weakness, trouble speaking, trouble seeing out of ½ of the visual field, trouble with coordination, (sudden severe dizziness, vomiting, double vision) severe headache often with neuro deficits.
What are the sudden signs and symptoms of stroke
This is the time window for IV alteplase (for stroke) administration
*Remember best practice is to administer it within 60 mins of the patient’s arrival
What is 3 to 4.5 hours after the onset of symptoms
This should be done within 4.5 hours with any measurable deficit, or within 24 hours with significant neuro deficit (NIHSS >6)
(includes wake up, and unknown time of last seen normal)
What is calling a Stroke Alert
This screening must be completed in Epic prior to administering PO medication which identifies a patient at risk for aspiration pneumonia
What is Dysphagia screening
This is the most common modifiable risk factor for stroke
What is hypertension
Motor function, sensory function, mental status, visual fields, speech fluency are part of this exam.
What is The NIHSS Exam
A Wake up stroke, a recent stroke within the last 3 months, recent major surgery, currently taking anticoagulants, INR >1.7, recent GI bleed
What are the contraindications to IV administering alteplase
These are 3 important parts of the Stroke Alert Process
What are:
Call the alert
Notify the MD
Bring the patient to CT
GOAL<10 min of arrival
This includes slurred speech, facial droop, lethargy, report of trouble swallowing
What are reasons for a Failed dysphagia screen
This type of stroke usually results in a sudden severe headache with neuro deficits, and often caused by uncontrolled hypertension
What is an intracerebral hemorrhage (hemorrhagic stroke)
These must be documented on stroke patients in the ED Q1 hour if the patient is critical; Q2 hours if the patient is not.
What are neuro assessments
Sudden neuro deterioration, sudden headache, sudden vomiting, oral angioedema, bleeding from the mouth, or nose.
What are the reasons for discontinuation of IV alteplase
This test is completed immediately to rule out intracerebral hemorrhage
What is a Non contrast head CT
*Remember the patient should go to CT within 10 mins of arrival
This is what we should do if a patient fails the dysphagia screen
What is to Keep patient NPO and notify MD
Hypertension, Diabetes, High Cholesterol, Cigarette smoking, Atrial Fibrillation, Obesity
What are risk factors for stroke
This is the most widely used assessment of stroke disability in the U.S. It has a score from 0 to 42.
What is The NIH Stroke Scale
185/110 to start the infusion, then less than 180/105 for the next 24 hours
What are BP parameters for IV alteplase
(*remember…repeat BP Q 5 mins X 2. If still elevated, get order for IV labetalol X one dose or cardene drip.
This is the ED triage power plan used for Stroke Alert patients
What is Triage Stroke
*Remember… this places an “urgent” CT head order and orders the STAT stroke labs. when you use the Neuro plan, the stroke labs aren’t ordered, and the CT is not ordered as “Urgent”
This is how we should administer ASA to a patient with slurred speech
What is PR
These patients have an increased risk of having a stroke within 30 days if they do not see a doctor and take the appropriate medications
What is a Transient Ischemic Attack
(complete and document neuro checks Q1 in CDU. The patient is at highest risk for stroke during these next 72 hours)
This is the reason why we should not lower BP in Acute Ischemic Stroke
What is To save threatened brain tissue by increasing perfusion
(we want to force blood and oxygen into the threatened brain tissue. Lowering BP would decrease perfusion, not increase it)
This is how is the IV alteplase dose calculated
0.9 mg/kg (Max 90mg)
10 % of the total dose given as IV bolus over 1 minute. 90% of the total dose infused over 60 mins
*Remember this requires 2 signatures
Pharmacy and RN
These are the stroke labs that are needed during a stroke alert
(*remember, don’t tube them, walk them to the lab and announce stroke alert)
What are BMP, CBC, and PT/INR
This is the reason why a CTA head and Neck is ordered for an acute stroke patient
What is to identify a large vessel occlusion
*eye deviation, aphasia, neglect are seen with large vessel occlusions