Inpatient Code Neuro Protocol - TECP EDU



Tacoma General Hospital - Inpatient Code Neuro Protocol

Criteria for initiating a Code Neuro: Acute Stroke Symptoms

- Sudden numbness or weakness of the face, arm or leg, especially if on one side of the body

- Sudden confusion, trouble speaking or understanding

- Sudden trouble seeing in one or both eyes

- Sudden trouble walking; dizziness and/or loss of balance or coordination

- Sudden severe headache with no known cause

FACE Does one side of the face droop?

Arms Does one arm drift downward?

Speech Are the words slurred or absent? Can the person repeat

a sentence correctly?

Time Note the time and determine LKW (when last known “well”)

Call a RRT first due to a change the patient’s condition. If a physician is at the bedside evaluating stroke-like symptoms, proceed directly to a Code Neuro.

Protocol for Code Neuro

1. Call x5555 to initiate Code Neuro. (Packets on Crash cart)

2. Patient’s RN notifies charge RN and remains at patient’s bedside

3. Patient’s RN performs/delegates POCT glucose and document on Code Neuro checklist

4. Patient’s RN records time of symptom onset or time patient LKW (i.e. without deficit). Give report to Code Neuro team, SBAR, most recent BUN/Creatinine, allergies. Stay at bedside to assist until transport to CT

5. Patient’s RN or charge RN notifies attending physician of patient’s condition.

6. ICU RN/Stat/Swat RN performs NIH Stroke Scale (use paper form for 1st one so CT tech can fax to radiologist)

GOAL: NIH SS < 10 minutes

7. MIS on call physician (403-2368) responds for patient evaluation and orders imaging (STROKE protocol) Head CT include comments “Code Neuro” when ordering

8. MIS on call physician calls NIR (Neurointerventional Radiologist) on call pager (888-200-9022) to report NIH SS, LKW, history, and IV status.

9. House supervisor plans for a bed in TGH Neuroscience ICU and facilitates transfer after head CT read as directed by physicians’ decision.

10. All present prepare patient to emergently transport to CT

GOAL: to CT < 20 minutes

Do not delay initial non contrast head CT if IV cannot be started < 10 minutes.

11. ICU RN/Stat/Swat RN or designee accompanies patient emergently to CT (along with all Code Neuro forms and patient’s chart)

12. Pharmacist role is to assist with medication administration and start t-PA Checklist

13. ICU RN/Stat/Swat RN or designee remains with patient-Repeat NIH SS and monitor VS every 5 minutes. 1:1 or 2:1 nursing care during imaging as

determined by patient’s condition. Transport to appropriate bed as directed by

physicians’ decision

GOAL: CT results to MIS or NIR physician < 45 minutes

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