1. Code Brain Attack Good Samaritan Hospital Written by: Diane King, Staff Nurse IV RN, MS, PHN, CEN

2.

• Goals and Objectives

• Goals

• By the end of this presentation will be able to describe:

• Basic stroke facts.

• Types of stroke.

• How staff members affect patient outcomes.

• Roles and responsibilities of primary nurse during. patient management.

3. Goals and Objectives

• Objectives

• What will learn and skills aught in this training deliver significant improvement in areas such as:

• Performance-Clinical implications of relevance.

• Productivity-Time lost is brain lost.

• Teamwork-Calling a brain attack, EKG, CT, Lab work, etc.

• Change Management-Agreement with other team members when patient situations change or resolve.

• Quality-Productive processes that are eagerly implemented, such as door to t-PA time 110 (antihypertensive treatment OK)

• Pregnancy, lactation, or parturition (childbirth) within previous 30 days

23. t-PA Inclusion/Exclusion

• Relative Contraindications:

• History of intracranial hemorrhage

• History of major trauma in the last 2 weeks

• Seizure at onset of stroke

• Active bacterial endocarditis

24. t-PA Administration

• Goal is door to t-PA time < 1 hour

25. t-PA Administration

• NIH stroke scale upon ER admission

• and prior to t-PA

• Establish 2 IV lines

• Primary line for t-PA

• Connect directly to IV tubing to infuse via pump

• Do not use t-PA as piggyback bag with

• .9NS as primary bag. Flush after t-PA is complete.

26. t-PA Administration

• Make sure that no other solutions or medications are running through t-PA line.

• Secondary line with .9NS

• Obtain established or actual body weight in kg

• Complete Inclusion/Exclusion criteria for t-PA

27. t-PA Administration

• Total dose (weight in _kg x 0.9 mg

• = total dose. Not to exceed 90 mg

• t-PA bolus 10% of total calculated dose given IV push over 1 minute

• t-PA remainder dose infused via separate pump/separate channel over 60 minutes

28. t-PA Administration

• Insert catheter tip into port closest to IV insertion site

• Visual confirmation of t-PA infusion every 15 minutes until infusion complete

• When t-PA infusion complete, follow with 50 ml .9NS at t-PA infusion rate through t-PA tubing

29. t-PA Administration

• Patient Management

• Patient to be staffed 1:1 ratio while in ER

• Vital signs TPR/BP, neuro checks every 15 minutes for 2 hours, then every 30 minutes

• No automatic BPs to be used until 24 hours after t-PA

• NIHSS every shift and STAT for significant changes

30. Time Clock

• The time clock should be started when the brain attack is called. The goal is door to t-PA time