Tessa Quinn
A stroke alert is a way to quickly get a patient the resources they need for timely stroke intervention. Strokes are the second leading cause of death worldwide and the fifth most common in the U.S. They happen when something cuts off the blood supply to the brain, and they can be fatal. As such, stroke alerts are critical in hospitals, as they can help to reduce delays and optimise treatment for patients. When a stroke alert is called, team members bring the necessary equipment and alert the CT scan technician to clear the scanner and prepare for the patient's arrival.
| Characteristics | Values |
|---|---|
| Purpose | To quickly get the patient the resources needed for timely stroke intervention |
| When to call | When you suspect your patient is having a stroke, no matter how minor the symptoms |
| Who responds | Neurologist, physician, advanced practice clinician, nurse, stroke coordinators, pharmacy personnel, transport personnel, respiratory therapist, phlebotomist, nursing aide, patient's primary care team |
| Time taken | Delayed compared to patients presenting to the emergency department |
| Treatment | Alteplase, neuro intervention, thrombectomies, CT scans, MRI scans |
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What You'll Learn
- Calling a stroke alert: the BE FAST acronym can help spot stroke symptoms
- Rapid intervention: key to minimising neurological deficits and improving outcomes
- In-hospital stroke care: creating rapid response teams with dedicated stroke training
- Stroke mimics: altered mental status without focal symptoms is a common stroke mimic
- Treatment: restoring normal blood flow to prevent permanent brain damage
Calling a stroke alert: the BE FAST acronym can help spot stroke symptoms
Strokes are life-threatening and require immediate treatment. They occur when something blocks blood flow to the brain, such as a blood clot or a broken vessel, cutting off the brain's oxygen supply and causing brain cell death. As such, time is critical when responding to a stroke, and rapid intervention is key to minimising neurological deficits and improving patient outcomes.
The BE FAST acronym is a helpful tool for identifying the signs of a stroke. Here is what each letter stands for:
B: Balance. Check if the patient has a sudden loss of balance, trouble with sitting or standing, or a lack of coordination.
E: Eyes. Observe if the patient has experienced any sudden changes in vision, such as blurred vision or loss of vision in one or both eyes.
F: Face. Ask the patient to smile and check for facial asymmetry or drooping.
Additionally, the FAST acronym can be used to spot stroke symptoms:
F: Face Drooping – Check for facial drooping or numbness, and ask the person to smile to see if their smile is uneven.
A: Arm Weakness – Ask the person to raise both arms and observe if one arm is weak or numb and drifts downward.
S: Speech – Listen for slurred or strange speech, or an inability to speak.
T: Time to act – Call emergency services immediately if you observe any of the above symptoms.
It is important to note that stroke symptoms can vary depending on the area of the brain affected. Some other common symptoms include aphasia (difficulty speaking or loss of speech), sudden numbness or weakness in the leg, sudden severe headache, and more.
When a stroke alert is called in a hospital setting, it activates a rapid response from a dedicated team with stroke training and access to neurological expertise. This team may include a neurologist, an advanced practice clinician or nurse, stroke coordinators, pharmacy personnel, and transport providers. The patient's primary care team should also be involved, and prompt communication of the care plan is crucial.
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Rapid intervention: key to minimising neurological deficits and improving outcomes
Stroke is a life-threatening medical condition that requires immediate treatment. It occurs when a blocked blood vessel or bleeding in the brain interrupts blood flow to the brain. The acronym BE FAST is often used to help identify the signs of a stroke: Balance, Eyes, Face, Arms, Speech, and Time. Face drooping, arm weakness, and speech difficulties are some of the most common symptoms. Recognizing these signs and acting quickly are crucial for improving patient outcomes.
When a stroke is suspected in a hospital setting, a stroke alert is activated to mobilize the necessary resources and personnel. This includes a neurologist or physician, an advanced practice clinician or nurse with stroke expertise, stroke coordinators, pharmacy staff, and transport personnel. Some hospitals may also include respiratory therapists, phlebotomists, or nursing aides. The patient's primary care team should also be involved, and telemedicine capabilities can be utilized to access neurological expertise if needed.
To optimize in-hospital stroke care and minimize neurological deficits, several best practices should be implemented:
- Provide stroke training to all hospital staff, including how to activate stroke alerts. This training should cover assessment tools and grading scores to improve stroke recognition.
- Establish rapid response teams with dedicated stroke training and immediate access to neurological expertise.
- Standardize the evaluation of patients with suspected strokes through physical assessment, imaging, and the National Institutes of Health Stroke Scale.
- Ensure prompt communication of the care plan between the response team and the patient's primary care team.
By following these practices and emphasizing rapid intervention, hospitals can improve patient outcomes and reduce the likelihood of permanent neurological damage caused by strokes.
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In-hospital stroke care: creating rapid response teams with dedicated stroke training
Stroke is a medical emergency, and rapid intervention is critical to minimising neurological damage and improving patient outcomes. Calling a stroke alert is the first step in getting a patient the resources they need for timely stroke intervention. As soon as a potential stroke is suspected, hospital staff should follow their facility's procedure for calling a stroke alert.
However, patients who experience an in-hospital stroke often face delays in evaluation and treatment compared to those presenting to the emergency department, leading to higher morbidity and mortality rates. To address this, hospitals should implement systems of care and targeted quality improvement initiatives. One key recommendation is to create rapid response teams with dedicated stroke training and immediate access to neurological expertise.
These rapid response teams should include members trained to provide homogeneous care for stroke patients. This means that while team members contribute different professional perspectives, goal setting, care planning, and decision-making are collaborative activities. For example, in the Helsinki model, team members understand the interdependence of their roles and share the responsibility for removing organisational and professional barriers to service improvements. This facilitates rapid information exchange, enables early interventions, and enhances rehabilitation in secondary care and community settings.
Additionally, written protocols are recommended to expedite treatment and ensure consistency. Necessary resources may include expedited transport, access to rapid imaging, thrombolytic drug availability, and staffing capable of rapidly delivering medical, endovascular, or surgical treatment. Hospitals should also establish written protocols defining processes and responsibilities in accordance with guidelines and policies, and review metrics such as the number of in-hospital stroke alerts, response times, imaging acquisition times, and treatment rates to support quality improvement and identify areas for enhancement.
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Stroke mimics: altered mental status without focal symptoms is a common stroke mimic
A stroke alert is called when a patient's neurological status acutely deteriorates. Inpatient strokes are an excellent opportunity for acute intervention and treatment, but over triaging mimics can be challenging. A stroke alert ensures the patient gets the resources and timely intervention they need.
Altered mental status (AMS) without focal neurological deficit is a poor predictor of an in-hospital stroke. AMS was the leading reason for consultation in 35.5% of stroke alerts. However, only 4.5% of calls for AMS without focal deficit were diagnosed with an acute/subacute stroke. The best predictors of stroke are a normal mental status and a focal neurological deficit.
Stroke mimics present with less clearly defined neurological symptoms that do not typically adhere to well-defined stroke syndromes. The suddeness of onset is not always evident, and fluctuations in severity are common. Systemic signs may include drowsiness, confusion, agitation, and fever. Common symptoms include vertigo, dizziness, altered level of consciousness, paraesthesia, numbness, monoplegia, speech dysfunction, limb ataxia, headache, and visual disturbances.
Migraine aura without headache is a frequent stroke mimic, with symptoms including paraesthesia and visual phenomena. When symptoms are prolonged, hemiplegic migraine may be suspected. Focal seizures are common in patients with a previous stroke, and post-ictal Todd's paralysis may be confused for acute stroke. Misdiagnosis of acute stroke is a significant issue, with up to 40% of patients admitted to the hospital with suspected acute stroke having an alternate diagnosis.
Functional neurological disorder (FND) is another type of stroke mimic. FND describes a problem with how the brain sends and receives information to the rest of the body. The symptoms of FND are real and functional, caused by a disorder of the nervous system rather than damage to the brain. FND can be diagnosed by a neurologist or neuropsychiatrist following a neurological examination.
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Treatment: restoring normal blood flow to prevent permanent brain damage
A stroke is a medical emergency that occurs when the brain is deprived of adequate blood flow. This can be due to a blocked blood vessel or bleeding in the brain. As brain cells require oxygen from fresh blood to survive, a stroke can lead to permanent brain damage and disability if not treated promptly.
Restoring normal blood flow to the brain is the most critical aspect of stroke treatment. The primary goal is to prevent permanent brain damage and reduce the severity of any potential harm. The treatment approach depends on whether the stroke is ischemic or hemorrhagic.
For ischemic strokes, caused by a blood clot blocking blood flow to the brain, thrombolytic medications are administered to dissolve the clot. Thrombectomies, a type of surgery, may also be performed to remove the clot. Alteplase, a weight-based medication, is often used and must be administered within a specific time frame, usually up to 9 hours but sometimes as early as 4.5 hours after the patient was "last seen normal" (LSN). Thrombectomies can be conducted up to 24 hours after LSN. To prevent internal bleeding, thrombolytic medications are typically given within the first four hours of stroke symptoms.
In the case of hemorrhagic strokes, the focus is on controlling the bleeding. Medications are administered to stop the bleeding in the brain and manage blood pressure. Surgery may also be necessary to reduce intracranial pressure.
Additionally, oxygen therapy may be provided to increase oxygen delivery to the brain, and blood sugar management is crucial to aid the brain's recovery process. In rare cases, mild intentional hypothermia may be induced to slow down brain damage.
Time is of the essence when treating strokes. Rapid intervention is key to minimising neurological deficits and improving patient outcomes. Early interventions can also reduce the risk of future strokes and associated cardiovascular problems.
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Frequently asked questions
A stroke alert is a way to quickly get a patient the resources they need for timely stroke intervention. It is similar to a Code Blue, where other team members come running with the necessary equipment. When a stroke alert is called, the CT scan technician is alerted to clear the scanner and prepare for the patient's arrival.
Signs of a stroke can be remembered using the acronym BE FAST:
- Balance: A person may have trouble with balance, standing, or sitting. They may appear to have a lack of coordination.
- Eyes: A person may experience a sudden change in vision, such as losing all or part of their field of vision or having blurred vision.
- Face: A person may have facial droop. Ask them to smile and assess for asymmetry. Ask them to close their eyes tightly and open them wide while raising their eyebrows.
Suspected stroke symptoms in hospitalized patients can often be confounded by medications, metabolic encephalopathy, and comorbid illness. Altered mental status without focal symptoms is more likely to be a stroke mimic. If a stroke is suspected, the hospital staff will follow their facility's procedure for calling a stroke alert. This may include activating a rapid response team with dedicated stroke training and immediate access to neurological expertise.
