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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