Code stroke is only called after a rapid response. if you have a concern that a patient is having a stroke, call a Rapid Response.
The ICU resident responding screens for a code stroke as part of their role in the RRT. See the RRT page for further detail.
this document lists the code stroke flow, responsibilities, and has the inpatient code stroke triggers.
please view the medical emergency response team (MERT) sharepoint for further information. This link is only accessible through a va computer.
The goal of Code Strokes is to have a streamlined process in order to minimize time to CT scan and evaluation for possible TPA or other intervention.
Upon arrival to a Rapid Response, if there is concern for stroke, make a BRIEF evaluation of the patient (minimal neuro exam, fingerstick, etc) and if deemed necessary, the MICU Team should call a CODE STROKE and immediately send the patient to the CT scanner. The Code Nurse (an ICU nurse) and MICU intern should accompany the patient to the CT scanner.
The CT Scan is the top priority. The MICU team can speak with Telehealth Neurology regarding triage if the patient needs MICU transfer.
Activate Code Stroke (5-5000) when patient meets activation criteria 2. Call Triage Report to National Telestroke: 469-627-4790 3 (back-up 877-676-3455). Ward/RRT Resident Activates “Telestroke” orderset in CPRS: NCCT, CTA, Labs
At the CT Scan, the Telehealth Neurologist will direct you through the NIH stroke scale, remotely review the CT imaging, and ultimately tell you what the next steps will be (TPA, transfer to OSH, do nothing, etc)
tPA → MICU (Goal: determine tPA candiates by 40 minutes; give tPA at 45 minutes)
IVH or LVO in need of thrombectomy → MICU → interfacility transfer
Stroke but no tPA → PCU
No Stroke → revert RRT disposition
If the patient does not require intervention or neurochecks more frequently than q4h, they may be returned to the medicine floor with a note describing the Code Stroke.
Make sure if you are admitting a Code Stroke patient to use the Stroke order set which will take you through best practices (please order a dysphagia screen for stroke patients).
For information on code blues and code hearts, see the MICU policy page.