ED Stroke Alert Objectives Identify risk factors for stroke and signs of stroke Review ED stroke incidence and implications Discuss activation of ED Stroke Alert Stroke or brain attack is the ID: 910424
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Slide1
ED
STROKE ALERT
Competency
Slide2ED
Stroke
Alert Objectives
Identify risk factors for stroke and signs of stroke Review ED stroke incidence and implicationsDiscuss activation of ED Stroke Alert
Slide3Stroke or “brain attack” is the:
5
th
leading cause of death#1 leading cause of disability Time = Brain 14 billion synapses = every minute32,000 brain cells = every second The AHA/ASA guidelines Recognition of stroke First line of defense
EMS
ED Nurse
Appropriate recognition and quick action
Good to know……
Goal: Early recognition and action!
Stroke Care Network
Slide4Stroke Risk Factors
Stroke Care Network
Age equal to or greater than 65
Hypertension & heart disease Atrial fibrillation Family or personal history of stroke / TIASmoking Obesity Diabetes
Coagulopathy
Alcohol and drug abuse
Inactivity Sickle Cell disease Intra-arterial surgery African Americans have higher incidence of stroke
Women have higher mortality from stroke than men
Slide5The 5 “Suddens”
Stroke Care Network
Stroke is a medical emergency!
Know these warning signs for stroke:
Sudden numbness, weakness, paralysis of face, arm and/or leg, especially on one side of the body
Sudden slur or difficulty with speech and/or understanding words/phrases
Sudden loss of vision, especially unilateral
Sudden unexplained dizziness or loss of balance
Sudden and severe unexplained headache
Slide6B.E. F.A.S.T.
for stroke
BALANCE:
Is the person having trouble walking? Loss of balance or coordination, dizziness. EYES: Is the person having trouble seeing? Change in vision in one or both eyes.
FACE:
Ask the person to smile. Does the smile look even? Face looks uneven, droopy or is numb.
ARM:
Ask the person to raise both arms. Does on arm drop down? Weakness or numbness in one arm or leg.
SPEECH: Does the person have trouble speaking or seem confused? Slurred or difficult speech.
TIME:Time lost = Brain lost. Not the time symptoms start and call 9-1-1 immediately.
Slide7ED Stroke Alert
TIME IS BRAIN!!!
Purpose:
Promote awareness of symptoms
Increase awareness of emergent status
Expedite and optimize
Slide8ED Stroke Alert Flow / Protocol
Slide9Flow / Protocol Details
Recognize symptoms of an Acute Stroke
Stabilize patient
Simultaneously: Use phone to page “Stroke Alert” overhead state location This overhead page will activate CT, Lab and ED staff. While transporting to CT assess ABC (Airway, Breathing & Circulation
)
Patient transfer to CT table
scan complete
Patient taken to assigned ED room – ready images – data sheet for radiologist read
Slide10Flow / Protocol Details cont.
RN / MD
neuro assessment / NIHSS / BS (if not completed by EMS)
Simultaneously: RN finish neuro assessment / NIHSS / confirm IV placementEKG completed / stroke labs (if appropriate; do not delay r-tPA unless medically necessary) Onsite read or UK
On site read – results called to ED by MD (+ or -)
UK – faxes result to radiology office – Rad tech hands to MD
If (-) bleed +TPA admin
call UK or CB stroke team
Chest X-ray complete (if appropriate; do not delay r-tPA unless medically necessary)
Slide11Conclusion
Be aware of stroke symptoms when assessing patients
Familiarize yourself with symptoms and expected flow
Quick actions and recognition can result in more timely treatment and improved outcomes for our patients.