Table of Contents
Activate case #
- Activate case 7111 – Neuro Intervention – Anesthesia to call back
- After anesthesia accepts, call x66310 or x 54472 to book via main OR – state the case is ‘E-Zero’ to start immediately (to ensure registered in SurgiNet)
- If case cancelled, call 66310 to let them know
Enter orders #
- PowerPlan: ED/NEURO Ischemic Stroke Reperfusion Treatment – IR Cerebral Thrombolysis orders
Contact family #
- Informed consent
- Confirm contact phone (e.g. cell #)
Prep patient #
- Foley
- Shave groin
- Transport monitor (by trauma bay)
Admit patient #
- Admit patient (x 62238)
- If patient intubated, also call PACU (x 64320)
- Notify neurology charge nurse (page 604-872-9855)
Time-out #
- Confirm blood pressure parameter with anesthesia (usual goal – maintain incoming BP)
- Confirm if stenting likely and discuss actions (e.g. NG for ASA)
Post-procedure #
- Write admission orders (always use PowerPlan: NEURO Ischemic Stroke Admission After Reperfusion — even if no TPA given)
- Choose Neuro Goals blood pressure parameter:
- If good reperfusion, usually < 140 / < 90
- If no reperfusion, usually keep post-TPA default
- All patients should get SCDs for DVT prophylaxis, even if no TPA was given
- Ensure leg stays flat to prevent hematoma – at least 6 hours
Post-CT #
- Confirm blood pressure parameter (may need lower target if blood on CT) — if so, MODIFY the existing Neuro Goals order
- Confirm if additional anti-thrombotic needed for stented patient
Return to ward #
- Document post-procedure neurological exam — do not test leg drift — only test distal foot movement
