B.A.P.E.T Brain Attack Protocol & Emergency Treatment

1. B.A.P.E.T Brain Attack Protocol & Emergency Treatment By: Nicole Florentine, Christina Lauderman Erin Patrick, & Kara Sharp

2. Cerebral Vascular Accident Ischemic Clot or plaque Transient Ischemic Attack Clot or plaque causes cerebral ischemia causing stroke-like symptoms Resolves quickly in less than 24 hours without intervention CT/MRI will be negative Types of Stroke

3. Hemorrhagic Stroke • Intracerebral • Subarachnoid

4. Recognizing Common Symptoms • Speech Difficulty • Weakness (especially one sided) • Facial droop • Numbness/ tingling of face or extremity

5. Atypical Symptoms • Dizziness • Acute onset of blurred vision/ loss of vision • New onset of seizures • Disequilibrium (balance issues) • Confusion

6. CVA Headache One- sided weakness Speech difficulty Numbness and tingling ICH “worst headache” Nausea Vomiting Generalized weakness Flu-like symptoms photophobia Headache •MIGRANE ־“band-like”, focal headache ־aura ־photophobia ־nausea ־vomiting ־history of migraines

7. Risk Factors • Age • Gender • Race (African American) • Past CVA/ TIA • Family history • Smoking • Obesity • Heart disease • Diabetes

8. Alert • Purpose- Rapid Intervention of patient with acute stroke • Acuteness determined by CT/ MRI • Anyone can place an alert!

9. ANYONE Can Place Alert! • ANYONE can place alert by calling UPMC Command at 412.647.5858 • If you even slightly suspect stroke symptoms, place an alert! It can be cancelled if determined later not to be a stroke • Patients have better outcomes if made an alert!

10. Benchmark/ Treatment Protocol • Benchmarks need to be met to continue our stoke accreditation • Treatment 1. Direct to treatment room 2. NIH stroke scale on arrival 3. MD and RN evaluation <10min 4. Vital Signs q5mins x3 then q15min 5. Blood Glucose Level

11. Benchmark/ Treatment Protocol 6. Labs drawn and sent within 15 minutes 7. CT scan <25minutes 8. CT read <45minutes 9. Chest X-Ray completed <45minutes 10. EKG done <45 minutes

12. Benchmark/ Treatment Protocol 11. NIH stroke scale needs completed to and from testing and every 1 hour 12. TPA given less than 3hours onset of stroke symptoms NIH/VS q15minutes 13. Angiogram <1 hour 14. Patient admitted to the floor <3hours

13. Benchmark/Treatment Protocol • Oral medications should NEVER be administered to the patient until their ability to swallow has been tested. • The nurse can perform bedside swallow testing to evaluate for deficits

14. Quality Assurance • Quality assurance reviews in the Emergency Room reveal that when all of these benchmarks are met, patient outcomes are significantly increased. • American Stroke Association states “a 32.5% decline in stroke death rates between 1999 and 2007 when stroke protocols are followed.”

15. References • Miller, J. & Mink, J. (2009). Acute Ischemic Stroke: Not a moment to lose. Nursing 2009, 39, 36-42. • Schwamm, L., Fayad, P., Acker, J., Duncan, P., Fonarow, G, Girgus, L., Goldstein, L., Gregory, T., Kelly-Hayes, R., Sacco, J., Saver, J., Segrest, W., Solis, P. & Yancy, C. (2010). Translating Evidence Into Practice: A decade of Efforts by The American Heart Association/American Stroke Association to Reduce Death and Disability Due to Stroke. A Presidential Advisory From the American Heart Association/American Stroke Association. Journal of the American Heart Association. ISSN: 1524-4628

16. References • Stroke Prevention Guidelines. National Stroke Association. Retrieved on April 18, 2010 from http://www.stroke.org/site/PagesServer?pagename=PREGUIDE • Stroke Warning Signs. American Heart Association. Retrieved on April 18, 2010 from http://www.americanheart.org/presenter.jhtml?identifier=4742

17. References • UPMC Stroke Education for Patients and Families • UPMC Mercy Hospital Medical Management of Stroke and Transient Ischemic Attack Policy • UPMC Mercy Hospital Acute Stroke and TIA Admission Order Sets