Stroke Alert

  • Respond to bedside
  • Briefly assess patient with BEFAST – Stroke or no stroke?
  • If possible acute stroke, FaceTime TeleStroke (7am-12midnight),
  • give KP phone to Charge/relief RN/ ANM for exam
  • Obtain history and review chart for Hx: ever head bleed, surgery in 3 weeks, GI bleed, platelets, sq heparin, anticoagulants (Warfarin, Pradaxa), other thrombolytic contraindications, POLST form
  • Enter Initial CVA/TIA Orderset for thrombolytic eligible patient
  • Evaluate most recent BP, GFR, RBS, is patient on SQ HEPARIN?
  • Examine patient for medical issues
  • Discuss with TeleStroke if potential thrombolytic/EST

If “Go” for Stroke Alert: *Note: Creatinine waived for Stroke Alerts*

  • Discuss w/ TeleStroke if any labs are needed – If YES, alert lab/RN.
  • No labs are needed for thrombolytic unless suspected abnormal (if on sq heparin need PTT)
  • If on Coumadin – need INR today
  • GFR in last 6 months
  • If BP >185/110, assure patient gets labetalol per order (labetalol up to 20mg, then nicardipine ggt are prechecked)
  • Update family
  • Accompany patient to CT
  • TeleStroke Physician obtain consent for CTA and order Thrombolytics for Ischemic Stroke

After CT/ CTA

  • Discuss w/ TeleStroke on patient destination
  • if NO thrombolytic and NO EST, back to floor if appropriate
  • if only thrombolytic, to ICU
  • if EST (+/- thrombolytic), inform House Sup of imminent transfer

ICU

  • Initiate post thrombolytic Orderset
  • Complete NIHSS and note if not already done
  • Update family
  • Call local on call neurologist if needed (i.e., post thrombolytic patient staying, non-thrombolytic patient with other neuro issue)