Stroke Patient Checklist and Core Measures

Acute Stroke Goals, Core Measures, Key Elements of Care, Checklist, and LKUSH: (see below) • LKUSH= time patient Last Known in Usual State of Health. • LKUSH is NOT the time when the patient was FOUND with the deficit. • Get LKUSH, NIHSS, modified Rankin Score. • Alteplase within 4.5 from LKUSH. • Endovascular within 24 hours from LKUSH. Some Acute Stroke Goals: • Alteplase: in under 40 minutes. • Endovascular: in under 90 minutes. • Not all patient with acute stroke are candidates for alteplase or endovascular Rx. • ONLY patients that will be considered for endovascular Rx should get CTA (about 85 ml contrast) and/or CTP (~45 ml contrast). • Weigh patient BEFORE placing on CT table. • Have Stroke Kit in CT suite. • HOB flat, monitor and maintain normo-volemia. AVOID albumin. • Blood pressure that is too low (less than SBP 120), or too high (more than SBP 220); for acute reperfusion procedures, probably the optimal range is SBP 140-180. • Patient NPO until OK to swallow safely, perform Swallowing Safety Screening. • Antithrombotic medication initiated before 2nd midnight (not the same as 48 hours). • Antiplatelet therapy, such as aspirin, is NOT an emergency. • Check ALL the Core Stroke Measures, systematically - the checklist becomes a useful tool. • DOCUMENT what is NOT done. • Insistent, relevant education to all patients, targeted to the individual risk factors. • Discharge on DAPT or SAPT (as clinically indicated), on statin, well educated, and if in atrial fib-flut on anticoagulant. • Most common stroke mimics: delirium, functional (about 20%), seizures, migraine, Bell's, hypo- or hyper-glycemia, among others. ---------------------------------------------------------- Some bibliography: • 2021 Stroke Prevention Guidelines: https://www.ahajournals.org/doi/pdf/1... • 2019 Acute Stroke Guidelines: https://www.ahajournals.org/doi/pdf/1... • 2018 Acute Stroke Guidelines: https://www.ahajournals.org/doi/pdf/1... ----------------------------------------------------------- Additional videos: • NIHSS concisely (under 9 minutes):    • The NIHSS Concisely   • A Swallowing Safety Screening video (9 min):    • Swallowing Safety Screening   • Alteplase reconstitution and administration (under 6 min):    • Alteplase reconstitution and administration   • Playlist: https://tinyurl.com/StrokeForHCPs -------------------------------------------------------- Disclaimer: The information is intended to be used as an educational reference tool. It does not replace or overrule the treating healthcare provider’s (HCP) judgement, critical thinking, individualization of care, or diagnosis. The information is as accurate as possible, but it does include and is permeated by my own experience. As information is subject to change, and the possibility of human error on my side, it is up to the treating HCP(s) to decide the relevance and appropriateness of this tool for their patients and context. Users have the responsibility to confirm the relevance and appropriateness of the information here provided. You are responsible for the care of your patient. This presentation and content should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the app and its content. Under no circumstances shall I/we be responsible for damages arising from use of software and its content. Use at your own risk. The video is provided "as is". You are responsible for keeping updated, and observing if this video's content continues to be relevant for your use. Please, refer to the primary sources. Use at your own risk. A.A. Jarquin-Valdivia, MD 2021