Harbor:Code stroke - Revision history

Bchap23: /* Overview */

2024-03-29T19:32:06Z

Overview

← Older revision		Revision as of 19:32, 29 March 2024
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	**CBC, Chem 14, Troponin, INR, CXR, ECG		**CBC, Chem 14, Troponin, INR, CXR, ECG
	*GET PATIENT TO CT NONCONTRAST ASAP! Labs, IV, NIHSS can be completed in CT if not already done.		*GET PATIENT TO CT NONCONTRAST ASAP! Labs, IV, NIHSS can be completed in CT if not already done.
	*Call Neuro resident ~~Spectralink 23369~~ if not present in 15 minutes; stroke attending on ~~amion~~ - ED provider gives report to Neuro resident		*Call Neuro resident x67707 if not present in 15 minutes; stroke attending on MedHub - ED provider gives report to Neuro resident
			** Give brief signout to neuro resident from triage - LKWT, deficit, known contraindications to tPA
	**Radiology calls Neuro resident for CT reads. To reach Neurorads: x2808 (days); US Radiology for night/weekends/holidays 1-866-448-7762.		**Radiology calls Neuro resident for CT reads. To reach Neurorads: x2808 (days); US Radiology for night/weekends/holidays 1-866-448-7762.
	**Neuro resident takes lead on consent and ordering tPA if patient is a candidate. If tPA being given, should be communicated to ED team.		**Neuro resident takes lead on consent and ordering tPA if patient is a candidate. If tPA being given, should be communicated to ED team.

Andreawu: /* Overview */

2022-05-03T20:09:46Z

Overview

← Older revision		Revision as of 20:09, 3 May 2022
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	==Overview==		==Overview==
	[[:File:ED Acute Stroke Flowchart 2.7.19.pdf]]		[[:File:ED Acute Stroke Flowchart 12.1.21.pdf]]

	*Activate for all focal neuro deficits with onset <24 hours		*Activate for all focal neuro deficits with onset <24 hours

Andreawu: /* Overview */

2019-02-26T22:27:49Z

Overview

← Older revision		Revision as of 22:27, 26 February 2019
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	**POC gluc, chem (for Cr), and INR, non-contrast CT brain. If no contraindication to contrast, CTA head and neck with CTP brain		**POC gluc, chem (for Cr), and INR, non-contrast CT brain. If no contraindication to contrast, CTA head and neck with CTP brain
	**CBC, Chem 14, Troponin, INR, CXR, ECG		**CBC, Chem 14, Troponin, INR, CXR, ECG
	*GET PATIENT TO CT NONCONTRAST ASAP! Labs, IV, NIHSS can be completed ~~afterwards~~ if not already done.		*GET PATIENT TO CT NONCONTRAST ASAP! Labs, IV, NIHSS can be completed in CT if not already done.
	*Call Neuro resident Spectralink 23369 if not present in 15 minutes; stroke attending on amion - ED provider gives report to Neuro resident		*Call Neuro resident Spectralink 23369 if not present in 15 minutes; stroke attending on amion - ED provider gives report to Neuro resident
	**~~Neuroradiology~~ for reads: x2808 (days); US Radiology for night/weekends/holidays 1-866-448-7762.		**Radiology calls Neuro resident for CT reads. To reach Neurorads: x2808 (days); US Radiology for night/weekends/holidays 1-866-448-7762.
	**Neuro resident takes lead on consent and ordering tPA if patient is a candidate. If tPA being given, should be communicated to ED team.		**Neuro resident takes lead on consent and ordering tPA if patient is a candidate. If tPA being given, should be communicated to ED team.
	**Neuro will contact Interventional Neuro for IA tPA or thrombectomy (p501-5423). If our IR does not have capacity, then Neuro resident will initiate transfer to Comprehensive Stroke Center.		**Neuro will contact Interventional Neuro for IA tPA or thrombectomy (p501-5423). If our IR does not have capacity, then Neuro resident will initiate transfer to Comprehensive Stroke Center.

Andreawu: /* CODE STROKE Procedure */

2019-02-26T22:26:22Z

CODE STROKE Procedure

← Older revision		Revision as of 22:26, 26 February 2019
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	* INCLUSION: age 18 years or older, new focal neurological deficit for <24 hours		* INCLUSION: age 18 years or older, new focal neurological deficit for <24 hours
	* Rooming:		* Rooming:
	** From Triage: BBN ~~and call~~ charge RN to ~~place in~~ AED room immediately		** From Triage: BBN, MSE provider places orders, get patient to CT ASAP. Call charge RN to ready AED room immediately
	** By Ambulance: room immediately		** By Ambulance: room immediately
	'''If no room available: ~~RN to start IVs, obtain POC and labs;~~ Initial ED MD evaluation then proceed directly to CT'''		'''If no room available: Initial ED MD evaluation then proceed directly to CT'''
			** RN to start IVs, obtain POC and labs; can be done in CT scanner
	* EVALUATION:		* EVALUATION:
	** Initial ED MD evaluation within 10 minutes		** Initial ED MD evaluation within 10 minutes
	** Stabilize ABCs		** Stabilize ABCs
	** Last known well time (LKWT), patient’s age, and deficit (consider deferring complete NIHSS until after activated)		** Last known well time (LKWT), patient’s age, and deficit (consider deferring complete NIHSS until after activated)
	* ACTIVATE CODE STROKE: notify ED clerk to page with information above: '''“code stroke, name/MRN if available, location, age, M/F, deficits~~/NIHSS~~, LKWT”'''		* ACTIVATE CODE STROKE: notify ED clerk to page with information above if available: '''“code stroke, name/MRN if available, location, age, M/F, symptoms/deficits, LKWT”'''
	** p0921: Batch page to Neurology (chief and attending, resident on call), lab, CT tech, radiology/IR, ED pharmacist, patient flow coordinator		** p0921: Batch page to Neurology (chief and attending, resident on call), lab, CT tech, radiology/IR, ED pharmacist, patient flow coordinator
	** Neurology to bedside to evaluate patient w/in 15min		** Neurology to bedside to evaluate patient w/in 15min
	* Prior to CT, in AED room		* Prior to CT, in AED room
	** Complete ED MD evaluation/orders: ~~Perform full NIHSS exam, and use~~ order set '''“ED Initial Acute Stroke”'''		** Complete ED MD evaluation/orders: order set '''“ED Initial Acute Stroke”'''
	** Automatic Imaging: CT head, CTA head and neck, CT cerebral perfusion study (can cancel later if a bleed on non-contrast CT)		** Automatic Imaging: CT head, CTA head and neck, CT cerebral perfusion study (can cancel later if a bleed on non-contrast CT)
	** Labs/Studies		** Labs/Studies
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	** Always CT head non-contrast		** Always CT head non-contrast
	** Complete NIHSS if not already done so		** Complete NIHSS if not already done so
	** IF high risk of Large Vessel Occlusion with NIHSS ≥ 6 obtain CT Perfusion and CTA Head and Neck at the same time [regardless of if Cr on POC testing]		** IF high risk of Large Vessel Occlusion with NIHSS ≥ 6 obtain CT Perfusion and CTA Head and Neck at the same time [regardless of if Cr on POC testing], discuss desired imaging with Neurology.
	* Back to AED room from CT		* Back to AED room from CT
	** RN to obtain weight from scale on bed, EKG/CXR and other studies as needed		** RN to obtain weight from scale on bed, EKG/CXR and other studies as needed

Andreawu: /* Overview */

2019-02-26T22:22:25Z

Overview

← Older revision		Revision as of 22:22, 26 February 2019
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	*Activate for all focal neuro deficits with onset <24 hours		*Activate for all focal neuro deficits with onset <24 hours
	**Pager 501-0921		**Charge RN/Clerk will batch page to Lead Pager 501-0921 with whatever clinical info is available and location of patient and overhead page.
	*~~Order~~:		* From TRIAGE: Router RN concern for possible stroke --> direct to provider in Team Triage --> MSE provider places code stroke orders from "ED Initial Acute Stroke" order set and works with Charge RN to get patient to non-con CT, and ready a bed for patient as BBN. MSE provider gives signout to new team physician at CT
	**~~Accucheck~~, non-contrast CT brain		*Orders via "ED Initial Acute Stroke" Orderset:
	if no contraindication to contrast, CTA ~~brain~~ and neck with CTP brain		**POC gluc, chem (for Cr), and INR, non-contrast CT brain. If no contraindication to contrast, CTA head and neck with CTP brain
	**CBC, Chem 14, Troponin, INR, CXR, ECG		**CBC, Chem 14, Troponin, INR, CXR, ECG
	*~~Re-page~~ if ~~neuro~~ resident not present in 15 minutes; stroke attending on amion		*GET PATIENT TO CT NONCONTRAST ASAP! Labs, IV, NIHSS can be completed afterwards if not already done.
	**~~neuro~~ resident ~~to assist with~~ tPA if patient is a candidate; should ~~consent acceptance or declination of tPA~~		*Call Neuro resident Spectralink 23369 if not present in 15 minutes; stroke attending on amion - ED provider gives report to Neuro resident
	**Interventional ~~neuro~~ for IA tPA or thrombectomy (~~501~~-5423)		**Neuroradiology for reads: x2808 (days); US Radiology for night/weekends/holidays 1-866-448-7762.
	**~~Neuroradiology for reads: x2808 (days); 501~~-~~5814 (nights)~~		**Neuro resident takes lead on consent and ordering tPA if patient is a candidate. If tPA being given, should be communicated to ED team.
	* ~~From TRIAGE: Router RN concern for possible stroke~~ --> direct to physician in Team Triage --> MSE provider places code stroke orders from "ED Initial Acute Stroke" order set and works with Charge RN to get patient to non-con CT, and ready a bed for patient as BBN. MSE provider gives signout to new team physician at CT		**Neuro will contact Interventional Neuro for IA tPA or thrombectomy (p501-5423). If our IR does not have capacity, then Neuro resident will initiate transfer to Comprehensive Stroke Center.
			***Long Beach 562-480-3487
			***Little Co of Mary, Torrance 310-4-STROKE

	==Phone Numbers==		==Phone Numbers==

Andreawu: /* Overview */

2019-02-26T22:11:46Z

Overview

← Older revision		Revision as of 22:11, 26 February 2019
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	==Overview==		==Overview==
			[[:File:ED Acute Stroke Flowchart 2.7.19.pdf]]

	*Activate for all focal neuro deficits with onset <24 hours		*Activate for all focal neuro deficits with onset <24 hours
	**Pager 501-0921		**Pager 501-0921

Bchap23: /* Overview */

2019-02-05T23:10:19Z

Overview

← Older revision		Revision as of 23:10, 5 February 2019
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	==Overview==		==Overview==
	*Activate for all focal neuro deficits with onset <8 hours		*Activate for all focal neuro deficits with onset <24 hours
	**Pager 501-~~0771~~		**Pager 501-0921
	*Order:		*Order:
	**Accucheck, non-contrast CT brain		**Accucheck, non-contrast CT brain

Bchap23: /* Overview */

2019-02-05T22:49:15Z

Overview

← Older revision		Revision as of 22:49, 5 February 2019
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	**Interventional neuro for IA tPA or thrombectomy (501-5423)		**Interventional neuro for IA tPA or thrombectomy (501-5423)
	**Neuroradiology for reads: x2808 (days); 501-5814 (nights)		**Neuroradiology for reads: x2808 (days); 501-5814 (nights)
	* From TRIAGE: Router RN concern for possible stroke --> direct to physician in Team Triage --> MSE provider places code stroke orders from "ED Stroke" order set and works with Charge RN to get patient to non-con CT, and ready a bed for patient as BBN. MSE provider gives signout to new team physician at CT		* From TRIAGE: Router RN concern for possible stroke --> direct to physician in Team Triage --> MSE provider places code stroke orders from "ED Initial Acute Stroke" order set and works with Charge RN to get patient to non-con CT, and ready a bed for patient as BBN. MSE provider gives signout to new team physician at CT

	==Phone Numbers==		==Phone Numbers==

Bchap23: /* Overview */

2019-02-05T22:48:45Z

Overview

← Older revision		Revision as of 22:48, 5 February 2019
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	**Interventional neuro for IA tPA or thrombectomy (501-5423)		**Interventional neuro for IA tPA or thrombectomy (501-5423)
	**Neuroradiology for reads: x2808 (days); 501-5814 (nights)		**Neuroradiology for reads: x2808 (days); 501-5814 (nights)
			* From TRIAGE: Router RN concern for possible stroke --> direct to physician in Team Triage --> MSE provider places code stroke orders from "ED Stroke" order set and works with Charge RN to get patient to non-con CT, and ready a bed for patient as BBN. MSE provider gives signout to new team physician at CT

	==Phone Numbers==		==Phone Numbers==

Rossdonaldson1: Text replacement - "Harbor:Operations manual" to "Harbor:Main"

2019-01-31T07:05:49Z

Text replacement - "Harbor:Operations manual" to "Harbor:Main"

← Older revision		Revision as of 07:05, 31 January 2019
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	==See Also==		==See Also==
	*[[Harbor:~~Operations manual~~]]		*[[Harbor:Main]]

	==References==		==References==