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B.A.P.E.T Brain Attack Protocol & Emergency Treatment. By: Nicole Florentine, Christina Lauderman Erin Patrick, & Kara Sharp. Cerebral Vascular Accident Ischemic Clot or plaque. Transient Ischemic Attack Clot or plaque causes cerebral ischemia causing stroke-like symptoms

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b a p e t brain attack protocol emergency treatment

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

By:

Nicole Florentine,

Christina Lauderman

Erin Patrick,

&

Kara Sharp

types of stroke
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
hemorrhagic stroke
Hemorrhagic Stroke
  • Intracerebral
  • Subarachnoid
recognizing common symptoms
Recognizing Common Symptoms
  • Speech Difficulty
  • Weakness (especially one sided)
  • Facial droop
  • Numbness/ tingling of face or extremity
atypical symptoms
Atypical Symptoms
  • Dizziness
  • Acute onset of blurred vision/ loss of vision
  • New onset of seizures
  • Disequilibrium (balance issues)
  • Confusion
headache
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

risk factors
Risk Factors
  • Age
  • Gender
  • Race (African American)
  • Past CVA/ TIA
  • Family history
  • Smoking
  • Obesity
  • Heart disease
  • Diabetes
alert
Alert
  • Purpose- Rapid Intervention of patient with acute stroke
  • Acuteness determined by CT/ MRI
  • Anyone can place an alert!
anyone can place alert
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!
benchmark treatment protocol
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

benchmark treatment protocol1
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

benchmark treatment protocol2
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

benchmark treatment protocol3
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
quality assurance
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.”
references
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
references1
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
references2
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