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Archive for the ‘Stroke/TIA’ Category

DESERVE

Kevin Munjal via mssm.edu
8:50 PM (18 minutes ago)

to EMFaculty, emresidents, Cindy, Veronica, Boden-Albala, Dwayne, Leigh
Hi everyone,

Following up on the brief inservice given at conference this week:

PLEASE MAKE EARLY REFERRALS OF PATIENTS WITH MILD STROKE OR TRANSIENT ISCHEMIC ATTACK TO THE DESERVE RESEARCH STUDY.

What is DESERVE?

Discharge Educational Strategies for Reduction of Vascular Events

Basically, it is an enhanced discharge and follow up experience for your patients. The study will randomize patients to either receive the special experimental program or usual care. If the intervention shows benefits, you will have helped your patients and possibly improve the way we care for all patients with TIA or minor strokes.

How to Refer a Patient?

Universal Pager available 24 hours a day / 7 days a week: 917-205-2440

Which Patients are Eligible?

Please refer all patients in the adult ED for whom you are concerned about mild stroke or TIA.

You do not need to worry about inclusion and exclusion criteria. The Study Research Team will ask you pertinent questions or obtain the information from the chart.
For those interested, they will exclude patients who are <18, have dementia, end stage cancer, significant disability prior to the event or otherwise unable to provide consent. They require the patient to have a vascular risk factor such as HTN, smoking, but a single measurement in the ED above 130/85 is good enough. They will likely capture patients admitted for stroke once they are in the hospital, but they do not mind finding out about these patients from you either. The real benefit, though, is when you let them know early about a patient who ends up getting discharged. When should I refer a patient? The earlier the better! Consider calling when: You have evaluated a patient and are considering TIA or Stroke in the differential You are writing your “provider note” and you use the template “Neurological Deficit or CVA” You decide to call Neurology for a neurological complaint that might be a TIA or Stroke You decide to get a head CT for a neurological complaint that might be a TIA or Stroke Neurology wants the patient to get an MRI which means the patient and family need something to do while waiting other than bug you every 15 minutes about how long they have been waiting for the MRI. Why can’t Neurology make these referrals? The ED does not always call Neurology for every TIA You know how long it takes Neurology to see your patients. Once neurology sees them, if the patient is ready to be discharged, there probably won’t be enough time to enroll them. How long does enrollment take? 30 min – 90 min depending on multiple factors. Will this mess with my ED throughput? No!! The DESERVE Team staff will be flexible around the patients clinical care needs. They will do enrollment and education at the bedside and pause for any clinical staff that need to interact with the patient or for patient transportation. If the patient is to be discharged and they have not completed their process, they will take the patient to a non-clinical area to complete enrollment. Any questions or issues, you can e-mail me or the Project Coordinator: Leigh Quarles at leigh.quarles@mountsinai.org Thanks, — Kevin G. Munjal, MD, MPH Assistant Professor, Associate Medical Director of Prehospital Care, Department of Emergency Medicine Mount Sinai Medical Center

Written by phil

February 16th, 2013 at 2:10 am

Posted in Stroke/TIA

PCC Study Synopsis

Written by phil

August 16th, 2010 at 7:48 pm

Stroke Protocol

Written by reuben

September 16th, 2008 at 10:04 pm

ABCD2 Score for TIA

The ABCD2 Score is being promulgated by the National Stroke Association as a clinical prediction rule to help dispo your TIA patients.

The Score

A = Age => 60 years 1 point
B = BP => 140mmHg or DBP => 90 mmHg 1 point
C = Clinical Features of TIA
– Unilat Weak w/o speech impairment 2 points
– Speech impairment w/o unilat weak 1 point
D = TIA Duration
– 10-59 min 2 points
– => 60 min 1 point
D2 = Diabetes 1 point

Prognostication:
Score 2d CVA Dispo
0-3 1% Admit for other considerations
4-5 4% Admit
6-7 8% Admit

Reference: Johnston SC, et al, “Validation and refinement of scores to predict very early stroke risk after transient ischemic attack” Lancet 369:283-292, 2007.

Written by phil

August 15th, 2008 at 2:15 pm

Posted in Stroke/TIA

USE OF rTPA (Activase) IN ACUTE STROKE

rTPA (Activase) available in 100mg vials and comes with

100ml vial of its own reconstitution fluid. (1mg/ml

concentration). Activase is located in medication room PYXIS.

DOSE FOR ACUTE STROKE:

0.9mg/kg is the total dose over 60 minutes

10% of total dose is given as initial bolus.

Example: patient weighs 70 kg

Total dose is 63mg (70kg X 0.9mg)

Initial bolus is 6.3ml (10% of 63mg)

56.7ml infusion over 60 minutes

PROCEDURE:

1. Establish total dose and initial bolus

2. Reconstitute rTPA (Activase) using the prepackaged fluid.

3. Draw initial bolus from rTPA.

4. Spike the rTPA vial with IV tubing.

5. Connect to IV pump and set the remaining dose over 1 hour.

6. Perform neuro checks every 15 minutes during rTPA infusion and every 30 minutes for the next 6 hours.

See Emergency Dept. Policies for “Protocol for the Initial Evaluation and Management of Patients with Ischemic and Hemorrhagic Stroke” for indications and contraindications in the use of rTPA.

Written by phil

February 14th, 2008 at 6:55 pm

Posted in Stroke/TIA