ED STROKE ALERT Competency

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

Good to know…… Goal: Early recognition and action! Stroke or “brain attack” is the: 5th leading cause of death #1 leading cause of disability Time = Brain 14 billion synapses = every minute 32,000 brain cells = every second The AHA/ASA guidelines Recognition of stroke First line of defense EMS ED Nurse Appropriate recognition and quick action Stroke Care Network

Stroke Risk Factors Age equal to or greater than 65 Hypertension & heart disease Atrial fibrillation Family or personal history of stroke / TIA Smoking 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 Stroke Care Network

Stroke is a medical emergency! Know these warning signs for stroke: The 5 “Suddens” 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 Stroke Care Network

B.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.

ED Stroke Alert Purpose: TIME IS BRAIN!!! Promote awareness of symptoms Increase awareness of emergent status Expedite and optimize TIME IS BRAIN!!!

ED Stroke Alert Flow / Protocol

Flow / 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

Flow / Protocol Details cont. RN / MD neuro assessment / NIHSS / BS (if not completed by EMS) Simultaneously: RN finish neuro assessment / NIHSS / confirm IV placement EKG 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)

Conclusion 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.