ED Staff suspicious of CVA

1. Lake Chelan Community Hospital Acute TeleStroke Algorithm ED Staff suspicious of CVA If EMS-: 1) Ask EMS to establish sx onset time: activate priority transport for all pts with onset <3.5 hrs, Activate MEDICAL ALERT 2) Labs (CBC, BMP and coags) and rapid glucose as per protocol drawn en route, and start 2 IV lines, DO NOT DELAY TRANSPORT 3) immediate PAC/MD evaluation upon arrival (follow algorithm) If walk-in/ inpatient: 1) establish sx onset time: a) if <3.5 hours - to ED room for immediate PAC/MD evaluation, Activate MEDICAL ALERT Facial weakness: new Arm/leg weak/numb: new Speech: slurred or word-finding problems: new Think: you think it might be a stroke. TIME IS BRAIN If desire to transfer to Swedish for care (e.g. hemorrhage, complicated stroke outside of IV telestroke window) Call 1-866-470-4233 (CAPP/Clinical Admission Patient Placement) and CAPP RN will facilitate discussion with appropriate SMC MD and bed placement If sx onset < 3.5 hours confirmed with persistent deficits GOAL: complete evaluation in < 45 minutes Acute TeleStroke PROTOCOL EVAL 1) Implement STROKE PROTOCOL 2) ED PAC/MD and ED RN: assess ABC, rapid neuro assessment. If confirmed continued focal neuro deficits sx <3.5 hours, ED PAC/MD to STAT page stroke team (206.405.7317). If telestroke candidate, set up room/prepare telestroke equipment. If possible Nurse to complete patient video conferencing consent. (If difficulty reaching stroke team pager above after 15 mins (with a 2nd page at 15 minutes), call 1-866-470-4233 & ask “Neurologist for stroke team” to be paged). 3) Send labs ‘ STROKE PANEL’ (CBC, PT/PTT, BMP, LDL, UHCG); STAT FSBS if not done by EMS Start 2 IVs if not already done 4) STAT Head CT - no contrast, “ Telestroke Patient”. If CT not ready, complete EKG and weight here. 5) ED PAC/MD or ED RN to do baseline NIHSS 6) EKG STAT 7) If potential IV alteplase candidate: a) Obtain scale weight b) Place 2nd IV 8) TELESTROKE CONSULTATION: a) ED PAC/MD or ED RN to repeat NIHSS exam prior to decision for medication b) ED PAC/MD & stroke team complete alteplase inclusion/contraindications and warnings document & make treatment decision c) Informed consent for alteplase completed 9) If ordered by ED PAC/MD, ED RN/Pharmacy to mix and deliver drug for administration 10) Fax Face Sheet to CAPP and to Sherene Schengel (206) 386-2626 Version October 2010