Stroke Alerts

TiggerBelly · Jul 1, 2016

Dizzy can be any number of things. I think it's a bit extreme to call a stroke alert just based on that assessment alone.

If someone presents with neurological issues that have started within the past eight hours, the ED physician is notified and presents to bedside.

He/she will do a quick neuro assessment (facial symmetry, gait, grips, etc) and if they feel it's legit then we call a stroke alert.

CT scan immediately, labs drawn (FSBS already was done while physician at bedside) monitor placed, IV established

We utilize Tele Neurology out of Charlestown. It's kinda like Skyping with a neurologist who will interview the patient/family, speak with physician and nurses and look at CT scan done

They give recommendations and we go off of that (TPA or not, transfer or not,etc)

I think that covers it

floridaRN38 · Jul 1, 2016

Yes. Me and the rest of the staff think it's a bit extreme. We r a level one trauma center. So we have tons of patients in and out daily. I think with the new "dizzy" protocol there were about 15 stroke alerts in one 12 hour shift. It was bananas!!

Lev, MSN, RN, NP · Jul 1, 2016

We do not call it for dizziness. (Although dizziness can be a sign of stroke). It is usually a complaint which would score on the NIH scale that activates the stroke alert.

Roy Fokker, BSN, RN · Jul 8, 2016

General consensus - when in doubt, call the stroke alert. Management wants us to err on the side of caution rather than miss a stroke (and I agree with the principle).

1. For walk in patients - stroke alert is usually issued by the triage nurse (based on quick subjective and objective assessment and VS). Notify CT and call the charge nurse - either charge accompanies pt. to CT or triage does (and charge covers triage). Regardless, a nurse is to accompany pt. to CT. Depending on who is going to CT with the patient, the other nurse assigns a bed and notifies the nurse assigned to the section. Said nurse scrambles to gather stuff (IVs, labs, meds etc.) while the tech prepares monitor, accucheck, EKG etc. While this is going on, triage/charge nurse notifies one of the docs so they can prepare as well.

2. For EMS patients (because they come through a different entrance), charge usually accompanies patient to CT - while notifying triage ("Don't use bed 12, I'm putting a stroke alert in there." etc.) Triage then calls over to the section to notify the RN and MD assigned to the section.

3. On most days, we actually have someone from Neurology come down to eval patient and develop treatment plan. On weekends/holidays/after-hours; tele-neurology is utilized. CT scan reads for stroke alerts are prioritized over all else (save trauma I think).

4. Every attempt is made to put in atleast 2 IVs and a foley if indicated. No invasive procedures once tPA is initiated.

5. Confirmed stroke alert patients rec. tPA are considered a 1:1 to the primary nurse. If we're lucky and have a float RN, that RN now takes over the assignment of the RN with the stroke patient. If no float available, the rest of the nurses split the patient load and cover [and the ER wait times just got that much longer.]

6. Baring any complications/instability - patient is usually admitted to ICU. If too unstable, transfer to nearest specialty neuro-center.

7. For inpatients, we now have a "Code Stroke" (just like a "Code Blue"). Similar concept, except this overhead page also alerts CT and lets them know to be ready to receive a stoke patient shortly, it also alerts nursing supervisor, RRT and lets unit secretary page for neurology (or whoever is on call.)

cheers,