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Code Stroke

Code Stroke. Presented by: Jonna Bobeck BSN, RN, CEN For Pullman Regional Hospital Emergency Department. Objectives. Understand emergency management of the adult stroke patient Discuss signs and symptoms of stroke Demonstrate stroke team composition Describe code team activation

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Code Stroke

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  1. Code Stroke Presented by: Jonna Bobeck BSN, RN, CEN For Pullman Regional Hospital Emergency Department

  2. Objectives • Understand emergency management of the adult stroke patient • Discuss signs and symptoms of stroke • Demonstrate stroke team composition • Describe code team activation • Discuss time from for treatment • Understand transfer guidelines

  3. Process for Utilization • F.A.S.T. Assessment • F=Face - Ask the person to Smile. Does one side of the face droop? • A= Arms - Ask the person to raise both arms. Does one arm drift downward? • S=Speech - Ask the person to repeat a simple sentence. Does the speech sound slurred or strange? • T=Time - Call 911 or get to the nearest stroke center or hospital

  4. Signs and Symptoms • Weakness, numbness or paralysis of the face, arm or leg: especially on one side of the body • Difficulty speaking or understanding simple statements • Sudden blurred or decreased vision in one or both eyes • Dizziness, loss of balance or coordination • Nausea or vomiting with any of the above symptoms • Sudden and severe headache with no apparent cause • Confusion or disorientation

  5. Stroke Team Composition • In the E.D. (Emergency Department): Emergency Department physician and RN’s, with additional support available if determined necessary. • In the Inpatient area: the Rapid Response Team (RRT) will respond to code Stroke. The RRT is composed of an ICU RN, Respiratory therapist, and Hospitalist if needed.

  6. Code Stroke Activation • The patient’s nurse performs a F.A.S.T. Stroke Assessment, if the patient is determined to be having signs and symptoms of a stroke the nurse will initiate Code Stroke by: • EMS – EMS will do F.A.S.T • Emergency Department - E.D. nurse / physician will assess patient for signs and symptoms of stroke during the triage process using the rapid neuro assessment technique. • Inpatients - : if signs and symptoms of a stroke present hospital staff and physicians will activate • Rapid Response Team and initiate Code Stroke

  7. Timeframe for Treatment • Time of onset of symptoms to time of tPA must be less than 4.5 hours • Patient may receive interventional therapy to treat stroke at a primary stroke center for up to 12 hours from the onset of symptoms

  8. Transfer Guidelines • Hemorragic strokes will be transferred to a primary stroke center if treatment is indicated. • Patients who receive tPA for stroke may remain at Pullman Regional Hospital. A consult with the Neurologist from a recognized stroke center is highly recommended to help guide the treatment decision.

  9. Quality Improvement • All patients that receive t-PA for stroke will be reviewed by the medical staff at Critical Care / Medicine. Data will be collected by nursing staff (Appendix F) and entered into a spread sheet that will be reviewed by the Medical Director of the Stroke Program and reported to Critical Care / Medicine Committee on an annual basis using the Critical Care Score Card (not included) and as needed.

  10. Reference • Pullman Regional Hospital. (2012). Code Stroke Emergency Assessment protocol Retrieved from \\prhs5\groups\Policies and Procedures\Patient Care

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