Stroke Facts
The most common type of stroke, accounting for 87% of all strokes.
What is ischemic?
Who can call a stroke alert?
Anyone! KRMC's policy is to discuss with the provider prior to calling an alert, but anyone can make the phone call.
The top priority for every stroke alert patient (after ABCs).
What is a non-contrast head CT?
This is our hospital's door-to-needle goal for giving tenecteplase. Hint: time in minutes
What is 45 minutes?
This is the top priority in care of the patient with altered LOC who may have suffered a stroke (hint: think ABCs).
What is maintaining the airway?
If the patient's symptoms started within the last ____ hours, we should call a stroke alert.
What is 24 hours?
This is what we are looking for on the non-contrast head CT.
What is hemorrhage?
This test should be done 24 hours after Tenecteplase (TNK) to confirm no hemorrhagic transformation.
What is non-contrast head CT?
This screening must be done prior to any oral intake. Hint: in Epic, there are two parts to this test and BOTH must be completed.
What is a dysphagia screening (swallow study)?
Epic has a Swallow Readiness screen as well as the Swallow Study. BOTH must be completed.
Which kills more women each year- breast cancer or stroke?
What is stroke?
This bedside test should be done either during or before calling a stroke alert to rule out this stroke-mimic.
Hint: two-part answer
What is a blood glucose?
What is hypoglycemia?
This test is definitive for ischemic stroke almost immediately, but takes longer to perform and interpret than CT.
What is MRI?
If the non-contrast head CT is negative, can we still give tenecteplase?
Yes. Non-contrast CT will only rule out hemorrhage. Ischemic stroke will not show up on a CT for 6-24 hours.
This is the earliest sign of neurological deterioration.
What is altered level of consciousness?
The acronym BE FAST stands for which common stroke symptoms?
Balance, Eyes (vision changes), Face (droop), Arms (drift/weakness), Speech (slurred or garbled), Time
Your patient went to bed normal at 2230. At 0300, he woke and called to go to the bathroom and was off-balance but said he was just tired. He woke up at 0715 with dizziness and blurred vision. When is his last known well (LKW)? Bonus: Does this scenario warrant a stroke alert?
2230
Bonus: Yes! We are within the 24-hour window to call a stroke alert.
This imaging test will show us if there is a large-vessel occlusion, or LVO. If positive, the patient may be able to undergo a thrombectomy to remove the clot.
What is CTA?
How is tenecteplase administered, and who can administer it?
Single IV push over 5 seconds, can be given by nursing staff (ER or ICU).
Patients are at risk for post-stroke depression. This screening must be done prior to discharge for any patient with a stroke/TIA diagnosis. Bonus: at what score must you notify the provider?
What is the PHQ-9 Depression Screening?
Bonus: score of 4 or higher
The most common cause of intracerebral hemorrhagic stroke.
What is hypertension?
This is where a stroke alert should be documented in Epic.
Inpatient: What is the BRRT/Code narrator (rapid response narrator)?
ED: What is the Stroke Narrator?
The procedure for a large-vessel occlusion where a catheter is threaded into the brain to retrieve a clot. Hint: we don't perform these at KRMC, the patient must be transferred.
What is thrombectomy? (mechanical thrombectomy, endovascular therapy (EVT))
This is KRMC's neuro check policy post-Tenecteplase.
-Every 15 minutes x 2 hours (ED/ICU)
-Every 30 minutes x 6 hours (ED/ICU)
-Hourly x 16 hours (while ICU status)
-Per unit protocol
KRMC's policy for how often/when to perform NIHSS assessments. Hint: There are 5 elements
What is on arrival, every shift, with any change in neuro status, and at transfer or discharge.
Bonus: which one of these do we miss on almost every single stroke patient?