When to Call a Stroke Alert: A Nurse's Guide to Timely Intervention

Understanding Stroke Alerts

• 🚨 A stroke alert functions similarly to a code blue, rapidly mobilizing necessary resources and personnel for timely stroke intervention.
• ⏱️ Time is brain; rapid intervention is critical for minimizing neurological deficits and improving patient outcomes.
• 🏥 Protocols may vary by facility, but the core concept is to quickly assess and treat suspected strokes.

Recognizing Stroke Symptoms (BE FAST Acronym)

• ⚖️ Balance: Sudden trouble with balance or coordination.
• 👀 Eyes: Sudden vision changes, blurred vision, or unequal pupil size.
• 😠 Face: Facial droop or asymmetry when smiling and showing teeth.
• 💪 Arms: Arm weakness or pronator drift when holding arms out with eyes closed; inability to move an arm.
• 🗣️ Speech: Slurred speech, difficulty finding words, or not understanding spoken language.
• ⏰ Time: Crucial for intervention; noting the time of symptom onset or last known normal is vital.

Stroke Alert Protocol and Diagnostics

• 🩺 The process typically involves an MD or rapid response nurse evaluation, often using the NIH Stroke Scale.
• CT scans, specifically a stat non-contrast head CT, are a priority, aiming for completion within 10 minutes.
• 💉 Two patent IV accesses are ensured, and labs including co-ag, CBC, and chemistry panels are drawn.
• 🧠 If the CT scan is negative for a bleed, the focus shifts to evaluating for thrombolytic drugs like alteplase (tPA) for ischemic strokes.
• 🫀 For hemorrhagic strokes, the plan centers on blood pressure control and potential surgical intervention.

Nursing Care During a Stroke Alert

• 🛡️ Patient safety is paramount; nurses must remain calm, composed, and convey competence.
• 🛏️ Ensure the patient is safely in bed and monitor vital signs, including potential need for supplemental oxygen.
• 🩸 Maintain optimal blood pressure and cerebral perfusion pressure, administering medications as ordered to raise or lower BP.
• 🌬️ Maintain a patent airway and prevent aspiration, especially by managing oral secretions and positioning the patient appropriately.
• 📈 Monitor for worsening or improvement of stroke symptoms, with neurological assessments (e.g., NIH Stroke Scale) performed frequently, especially after tPA administration.

Treatment Options

• 💊 Alteplase (tPA) can break up clots and restore blood flow, with administration guidelines evolving to include longer time frames (up to 9 hours, sometimes 4.5 hours, depending on facility protocols).
• 🫀 Thrombectomies, performed in interventional radiology, can remove clots and are available for patients up to 24 hours since last known normal.
• 🩺 The decision for thrombolytics or thrombectomy depends on factors like time since last seen normal, medical history, blood pressure, and bleeding status.