2. B.A.P.E.T Brain Attack Protocol & Emergency Treatment By: Nicole Florentine, Christina Lauderman Erin Patrick, & Kara Sharp

3. Types of Stroke Cerebral Vascular Accident Cerebral Vascular Accident –Ischemic –Clot or plaque Transient Ischemic Attack Transient Ischemic Attack –Clot or plaque causes cerebral ischemia causing stroke-like symptoms –Resolves quickly in less than 24 hours without intervention –CT/MRI will be negative

4. Hemorrhagic Stroke Intracerebral Intracerebral Subarachnoid Subarachnoid

5. Recognizing Common Symptoms Speech Difficulty Speech Difficulty Weakness (especially one sided) Weakness (especially one sided) Facial droop Facial droop Numbness/ tingling of face or extremity Numbness/ tingling of face or extremity

6. Atypical Symptoms Dizziness Dizziness Acute onset of blurred vision/ loss of vision Acute onset of blurred vision/ loss of vision New onset of seizures New onset of seizures Disequilibrium (balance issues) Disequilibrium (balance issues) Confusion Confusion

7. Headache CVA CVA –Headache –One- sided weakness –Speech difficulty –Numbness and tingling ICH ICH –“worst headache” –Nausea –Vomiting –Generalized weakness –Flu-like symptoms –photophobia MIGRANE ־“band-like”, focal headache ־aura ־photophobia ־nausea ־vomiting ־history of migraines

8. Risk Factors Age Age Gender Gender Race (African American) Race (African American) Past CVA/ TIA Past CVA/ TIA Family history Family history Smoking Smoking Obesity Obesity Heart disease Heart disease Diabetes Diabetes

9. Alert Purpose- Rapid Intervention of patient with acute stroke Purpose- Rapid Intervention of patient with acute stroke Acuteness determined by CT/ MRI Acuteness determined by CT/ MRI Anyone can place an alert! Anyone can place an alert!

10. ANYONE Can Place Alert! ANYONE can place alert by calling UPMC Command at 412.647.5858 ANYONE can place alert by calling UPMC Command at 412.647.5858 If you even slightly suspect stroke symptoms, place an alert! It can be cancelled if determined later not to be a stroke If you even slightly suspect stroke symptoms, place an alert! It can be cancelled if determined later not to be a stroke Patients have better outcomes if made an alert! Patients have better outcomes if made an alert!

11. Benchmark/ Treatment Protocol Benchmarks need to be met to continue our stoke accreditation Benchmarks need to be met to continue our stoke accreditation Treatment Treatment 1. Direct to treatment room 2. NIH stroke scale on arrival 3. MD and RN evaluation <10min 4. Vital Signs q5mins x3 then q15min 5. Blood Glucose Level

12. Benchmark/ Treatment Protocol 6. Labs drawn and sent within 15 minutes 7. CT scan <25minutes 8. CT read <45minutes 9. Chest X-Ray completed <45minutes 10. EKG done <45 minutes

13. Benchmark/ Treatment Protocol 11. NIH stroke scale needs completed to and from testing and every 1 hour 12. TPA given less than 3hours onset of stroke symptoms NIH/VS q15minutes 13. Angiogram <1 hour 14. Patient admitted to the floor <3hours

14. Benchmark/Treatment Protocol Oral medications should NEVER be administered to the patient until their ability to swallow has been tested. Oral medications should NEVER be administered to the patient until their ability to swallow has been tested. The nurse can perform bedside swallow testing to evaluate for deficits The nurse can perform bedside swallow testing to evaluate for deficits

15. Quality Assurance Quality assurance reviews in the Emergency Room reveal that when all of these benchmarks are met, patient outcomes are significantly increased. Quality assurance reviews in the Emergency Room reveal that when all of these benchmarks are met, patient outcomes are significantly increased. American Stroke Association states “a 32.5% decline in stroke death rates between 1999 and 2007 when stroke protocols are followed.” American Stroke Association states “a 32.5% decline in stroke death rates between 1999 and 2007 when stroke protocols are followed.”

16. References Miller, J. & Mink, J. (2009). Acute Ischemic Stroke: Not a moment to lose. Nursing 2009, 39, 36-42. Miller, J. & Mink, J. (2009). Acute Ischemic Stroke: Not a moment to lose. Nursing 2009, 39, 36-42. Schwamm, L., Fayad, P., Acker, J., Duncan, P., Fonarow, G, Girgus, L., Goldstein, L., Gregory, T., Kelly-Hayes, R., Sacco, J., Saver, J., Segrest, W., Solis, P. & Yancy, C. (2010). Translating Evidence Into Practice: A decade of Efforts by The American Heart Association/American Stroke Association to Reduce Death and Disability Due to Stroke. A Presidential Advisory From the American Heart Association/American Stroke Association. Journal of the American Heart Association. ISSN: 1524-4628 Schwamm, L., Fayad, P., Acker, J., Duncan, P., Fonarow, G, Girgus, L., Goldstein, L., Gregory, T., Kelly-Hayes, R., Sacco, J., Saver, J., Segrest, W., Solis, P. & Yancy, C. (2010). Translating Evidence Into Practice: A decade of Efforts by The American Heart Association/American Stroke Association to Reduce Death and Disability Due to Stroke. A Presidential Advisory From the American Heart Association/American Stroke Association. Journal of the American Heart Association. ISSN: 1524-4628

17. References Stroke Prevention Guidelines. National Stroke Association. Retrieved on April 18, 2010 from http://www.stroke.org/site/PagesServer?pagena me=PREGUIDE Stroke Prevention Guidelines. National Stroke Association. Retrieved on April 18, 2010 from http://www.stroke.org/site/PagesServer?pagena me=PREGUIDE http://www.stroke.org/site/PagesServer?pagena me=PREGUIDE http://www.stroke.org/site/PagesServer?pagena me=PREGUIDE Stroke Warning Signs. American Heart Association. Retrieved on April 18, 2010 from http://www.americanheart.org/presenter.jhtml?i dentifier=4742 Stroke Warning Signs. American Heart Association. Retrieved on April 18, 2010 from http://www.americanheart.org/presenter.jhtml?i dentifier=4742

18. References UPMC Stroke Education for Patients and Families UPMC Stroke Education for Patients and Families UPMC Mercy Hospital Medical Management of Stroke and Transient Ischemic Attack Policy UPMC Mercy Hospital Medical Management of Stroke and Transient Ischemic Attack Policy UPMC Mercy Hospital Acute Stroke and TIA Admission Order Sets UPMC Mercy Hospital Acute Stroke and TIA Admission Order Sets