1. ED STROKE ALERT Competency

2. 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

3. 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

4. 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

5. 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

6. 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 immediately.

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

8. ED Stroke Alert Flow / Protocol

9. 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

10. 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)

11. 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.