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Stroke Thrombolysis

Stroke Thrombolysis. University Hospitals Bristol. Stroke Thrombolysis (TL) at UHB. Approx 600 stroke admits per annum 0800-2300hrs Mon-Friday Night/ weekend divert to NBT ED only act as triage, then put out TL call. GIM SPR deliver out of hours TL with AGWS support.

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Stroke Thrombolysis

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  1. Stroke Thrombolysis University Hospitals Bristol

  2. Stroke Thrombolysis (TL) at UHB • Approx 600 stroke admits per annum • 0800-2300hrs Mon-Friday • Night/ weekend divert to NBT • ED only act as triage, then put out TL call. • GIM SPR deliver out of hours TL with AGWS support

  3. Senior Specialist Input • Vital early on to gain experience/confidence • Very helpful for quick decision if complex case • Actively lower BP to treat • Confidence to treat milder stroke • Teach stroke fellow/ GIM SPr

  4. Stroke Ward Nurse • Specialist skills and knowledge • Brings pack/ drugs • Supports GIM SpRegistrar OOH • Patient advocate • Seamless care up to stroke ward

  5. Stroke Thrombolysis at UHB 52 17 23 10

  6. % of Ischemic Stroke TL SEP 2010 - JUL 2011

  7. Why do we not thrombolyse 15% We don’t know, do you?

  8. Failure to spot stroke • ED nurse triage reliance on FAST alone • Failure to use ROSIER • Missed HHA and Inattention • Missed posterior circulation stroke

  9. ED – Stroke Service Interface • Education re limitations of FAST • ROSIER • ICE CT scan prompt • TEN TOP TIPS into ED handbook • Stroke bleep in hours • Regular feedback to ED

  10. Failure to assess for TL • NIHSS/ TL trained personnel always available • CT Scan availability • Was TL considered at all? • Was the decision not to TL correct?

  11. Thrombolysis Exception Report • Real time audit of all stroke admits • Arrival within 3.5 hours of known time of onset • Time to CT/TL considered, not TL’d why not? • Feed back monthly to ED/M&M/take teams

  12. TOP TIPS • Consider Stroke in any patient of any age with abrupt abnormal neurology • Then do a ROSIER score http://www.donsims.btinternet.co.uk/recognition.html • Do not rely on FAST alone • Always check for Hemianopia and for visual or sensory inattention • Urgently consider thrombolysis if definite time of onset within 4 hours and any persistent neurology • Scan all suspected stroke urgently……

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