1. Please read the following scenarios
and complete the post test.

2. A Code Stroke will be initiated when a
patient develops a sudden onset of one or
more of the following symptoms with the last
known "baseline/normal" time less than 4.5
hours:
 Numbness or weakness of the face, arm or leg,
especially on one side of the body.
 Sudden onset of blurred or decreased vision
in one or both eyes.
 Difficulty speaking or understanding simple
statements.


3. *** It is the primary RNs
responsibility to notify the MD of
a potential code stroke ***

4.  The ECC MD assesses a suspected stroke
patient within 10 minutes of arrival to the
ECC.
 All lab work is drawn and sent with the
awaiting lab technician prior to the CT.
 EKG (don’t hold the patient in triage to
perform….obtain in pt room so the ECC MD
can begin assessment).
 FSBG

5.  Door to CT time: A STAT CT of the Head
without contrast must be performed within
25 minutes.
 All patients receiving tPA will have an actual
weight prior to dosing. (use stretcher with
scales)
 Door to needle time: tPA is administered
within 60 minutes of patient’s arrival to the
ECC.

6.  Approximately 800,000 people suffer from a
stroke/TIA in the US annually.
 Stroke is the 4th leading cause of death in the
US.
 A CT of the Head without contrast is
performed to rule out a hemorrhage or
tumor.
 An acute ischemic stroke may not be visible
on a head CT for 24 hours.

7.  What do you do if a patient presents with
acute neurological changes outside the 4.5
hour window?
 The ECC MD can STAT consult a neurologist to
evaluate the patient. Other interventions may be
warranted (i.e. vascular procedures, EEG, etc.)
 CMC-NorthEast currently has 4 inpatient
Neurologists and 2 Nurse Practitioners.
 A neurologist is on call 24/7/365.

8.  Document the following times:
 Patient arrival to ECC
 Time last seen at baseline
 ECC MD in room
 Code Stroke called
 Neurologist in room
 Dysphagia screening
 tPA start time (if applicable)

10. FAQs
 What if the patient is a difficult stick?
Do we
hold the CT until the lab work is completed?
 NO. Send the patient to CT and call the IV team
to be available once patient returns from CT.
 What if a neurologist hasn’t arrived within 10
minutes of a code stroke call?
 Have the operator re-page the code stroke again.

11.  Mrs. Jones, 49 years old, presents to the ECC
with dizziness and difficulty walking that
started 45 minutes ago while she was
preparing breakfast. She is triaged and sent
to the waiting room. Two hours later she
receives a room. Another hour passes before
the MD assesses her. After assessing the
patient, a code stroke is activated.

12. What went wrong with this scenario?
A. Mrs. Jones waited too long to present to the
ECC.
B. Mrs. Jones waited in the waiting room for 2
hours.
C. One hour passed before Mrs. Jones is
assessed by the MD.
D. B and C
E. A and C
F. All of the above

13.  Mr. Smith, a 79 year old, is brought via EMS
from a skilled nursing facility with drooling,
decreased responsiveness, and leaning
towards the left side. The nurses at the facility
report he started acting less responsive last
night.
 True or False: This warrants immediate
notification to the physician of a possible code
stroke.

14.  Mr. Doe is a 27 year old male that presents
with acute confusion and “staring into
space”. His girlfriend states they had just left
a movie about 30 minutes ago and he started
acting “strange” on the way home.
 True or False: This warrants immediate
notification to the physician of a possible
code stroke.

15.  Ms. Whitley teaches at a local elementary
school. While lecturing, she began speaking
“gibberish” per the students. When she
arrives at the hospital 50 minutes later she
continues to speak incomprehensible words.
 True or False: This warrants immediate
notification to the physician of a possible
code stroke.

16. True or False Questions
 True or False:
It is ok to use the patient’s
stated weight for tPA dosing.
 True or False:
The ECC MD must assess a
suspected code stroke patient within 10
minutes.
 True or False:Lab work can be obtained after
the head CT if the patient is a difficult stick.