ED Code Stroke by

Code Stroke Criteria

biancabrooks — 2023-07-06 15:53:54 UTC

biancabrooks — 2023-07-06 15:56:12 UTC

B = BALANCE Sudden trouble walking, dizziness, loss of balance or coordination

biancabrooks — 2023-07-06 15:57:46 UTC

E = EYESIGHT Sudden trouble seeing in one or both eyes

biancabrooks — 2023-07-06 16:00:48 UTC

F = FACIAL DROOP Sudden weakness or numbness of the face

biancabrooks — 2023-07-06 16:07:19 UTC

A = ARM DRIFT Sudden weakness or numbness of the arm and/or leg, especially on one side of the body

biancabrooks — 2023-07-06 16:08:27 UTC

S = SPEECH Sudden confusion, trouble speaking or understanding

biancabrooks — 2023-07-06 16:09:52 UTC

T = TIME IS BRAIN Call 33333 for Stroke Activation/Rapid Response. If at CBOC call 911

STROKE STOP

biancabrooks — 2023-07-06 16:15:04 UTC

Check ABCs - Vital Signs
Determine LKW (Last Known Well)
POC Glucose
NIHSS or neuro check
Transport veteran to CT
Acquire pt weight
Administer O2 if Sats <94%

To initiate Code Stroke

biancabrooks — 2023-07-06 19:39:44 UTC

Call 33333
Use ED Code Stroke Pathway
Contact Telestroke at (469) 627- 4790 or (224) 240 - 7890
Contact CT and transport to CT stat!

Telestroke Worksheet

biancabrooks — 2023-07-06 20:26:33 UTC

biancabrooks — 2023-07-21 18:37:01 UTC

Acute Stroke Timeline

biancabrooks — 2023-10-06 15:47:08 UTC

Brief Focused History

biancabrooks — 2023-10-06 15:50:50 UTC

Taking anticoagulant? If so, what? When was the last dose?
Recent surgery or procedure?
Recent severe bleeding?
History of any brain bleed?
Any other pertinent history?

Know the BP goal!

biancabrooks — 2023-10-06 16:02:51 UTC

Appropriate BP management is essential for patient survival.
ALWAYS clarify BP goals with provider and KEEP BP within GOAL!
Check BP after every BP med and q 15 mins while titrating drip.
Never drop BP by more then 25% in 1st hour.

Ischemic Stroke BP Goals

biancabrooks — 2023-10-06 16:07:19 UTC

Intervention anticipated:

<185/110 to give thrombolytic
<180/105 post thrombolytic
<220/120 if no intervention

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Avoid hyptoension! Generally do not drop <140 1st 24 hours

Hemorrhage (ICH, SAH) BP Goals

biancabrooks — 2023-10-06 16:09:45 UTC

Ask provider for goal
Goal range generally 140-160 SBP

biancabrooks — 2023-10-06 16:27:36 UTC

biancabrooks — 2023-10-06 16:31:37 UTC

biancabrooks — 2023-10-06 16:31:58 UTC

biancabrooks — 2023-10-06 16:46:00 UTC

IPAD Instructions

biancabrooks — 2023-10-06 16:46:58 UTC

biancabrooks — 2023-10-06 17:35:36 UTC

biancabrooks — 2023-10-06 17:46:10 UTC

biancabrooks — 2023-10-06 17:55:06 UTC

biancabrooks — 2023-10-06 17:55:46 UTC

Alteplase Indication

biancabrooks — 2023-10-06 18:05:44 UTC

Clinical diagnosis of ischemic stroke with potentially disabling neurologic deficit
LKW established as <4.5 hours (270 minutes) before treatment can begin

Thrombolytic should be given after CT of head

biancabrooks — 2023-10-06 18:09:13 UTC

While Stroke Neurologist determines eligibility:

Manage BP
Weight Pt (if not already done)
Calculate dose with 2nd nurse and Neurologist
Provider to retrieve consent

Alteplase exclusion criteria

biancabrooks — 2023-10-06 18:17:06 UTC

biancabrooks — 2023-10-06 18:18:24 UTC

TPA Reconstitution and Administration

biancabrooks — 2023-10-06 18:56:26 UTC

Stroke kit

biancabrooks — 2023-10-07 12:38:52 UTC

TPA Calculations

biancabrooks — 2023-10-07 12:56:02 UTC

Monitoring

biancabrooks — 2023-10-07 13:02:41 UTC

Stroke Activation

biancabrooks — 2023-10-07 13:15:07 UTC

Swallow Screen

biancabrooks — 2023-10-07 13:18:24 UTC

NIH Stroke Scale

biancabrooks — 2023-10-07 13:19:41 UTC

biancabrooks — 2023-10-10 19:32:48 UTC