BRAIN ATTACK KEY POINTS

 

* ED Patients must be assessed <15 minutes from arrival. Goal is ASAP!

 

* Do not call a Brain Attack until you have a glucose level

 

* Know your Inclusion and Exclusion criteria well for the 3hr and 4.5 hour windows

 

* If a patient has taken a DOAC: Direct Oral Anticoagulant: (i.e. Xarelto, Pradaxa, Eliquis) within 48 hours, do NOT give tPA

 

* If NIHSS is 6 or higher, you must select the CT Angio Head and Neck for BHCS on the EMR Brain

Attack Careset, so that these exams are done right after the patient gets their Non-contrast CT Brain all in 1 trip

 

* For Wake up strokes: if NIHSS is 6 or higher, Activate the Brain Attack Process, get the CT Angio Head and Neck

* ********Call the Neuro-interventionalist immediately after the CT Angio is completed and Patient returns from CT Scan********** Do not wait for Radiologist report for this. It will be a significant delay: hours…..The Neuro-interventionalist is able to review the images right away and instruct you to transfer patient if a LVO (Large Vessel Occlusion) is found

 

* Our tPA is Door to Needle time needs to be <45 minutes!!! GOAL is ASAP!!!

 

***Every minute during an untreated CVA, the patient has 1.9 million neurons dying!***

 

* On Call Neurologist must see patient in person or perform Telemedicine. Do NOT delay tPA for this process.

 

* NIHSS of 1, patient is still a candidate for tPA if within the window.

 

* NIHSS needs to be documented by us for all suspected CVA or TIA patients