Shands at the University of Florida Stroke Program The only Comprehensive Stroke Center in north central Florida as designated by the Florida Agency for Health Care Administration. To transfer a stroke patient call Shands at UF Transfer Center: 800-987-2673 www.stroke.ufandshands.org
When to consider a transfer to Shands at the University of Florida Stroke Program Hemorrhagic Stroke Ischemic Stroke Large volume intracerebral hematoma greater than 5 cm on CT Concern for expanding hematoma Hunt Hess Score 3 NIHSS 6 Signs & symptoms consistent with large vessel occlusion ( Drip and Ship ) Stroke in the young (<55 yo) Rapidly declining mental status, especially requiring intubation All SAH
Acute Stroke Transfer Guidelines 1. Patient name: Last First Date: EMT performing field assessment Time: 2. Information / history from: [ ] Patient [ ] Family member \ Phone: (authorized to give consent) Name (Phone en-route) 3. Last known time patient was at baseline or deficit free and awake: Time: Date: TIME OF SYMPTOM ONSET: AM PM CODE STROKE CRITERIA: YES UNKNOWN NO 4. Symptom duration less than 4.5 hours [ ] [ ] [ ] 5. Blood glucose between 80 and 400: [ ] [ ] [ ] 6. OBVIOUS ASYMMETRY Normal Right Left Facial: smile/grimace [ ] [ ] Absent/lax [ ] Absent/lax Grip [ ] [ ] Weak [ ] Weak [ ] No grip [ ] No grip Arm drift [ ] [ ] Drifts down [ ] Drifts down [ ] Falls rapidly [ ] Falls rapidly Based on exam, patient has only unilateral (not bilateral) weakness: Yes [ ] No [ ] In no circumstances should acquisition of these items delay the transfer of the patient. Urgent transfer minimizing time to presentation is an absolute priority.
Acute Stroke Transfer Guidelines 7. LANGUAGE: Appropriate Inappropriate LOC Questions (alert/verbal/painful/unresponsive) [ ] [ ] LOC Commands (close eyes, make fist) [ ] [ ] Language (repeat sentence, name objects) [ ] [ ] Speech clarity (evaluate for slurring) [ ] [ ] Based on assessment, patient has new onset language/orientation deficit: Yes [ ] No [ ] 8. Items 4-7 all Yes (or unknown) CODE STROKE CRITERIA MET Yes [ ] No [ ] Onset of symptoms plus transport time < 4.5 hours Yes [ ] No [ ] If criteria are met, call receiving hospital with a Stroke Alert.
Acute Stroke Transfer Checklist When preparing to transfer an acute stroke patient to the Shands at UF Stroke Center, please make every attempt to include the following information. Results of all diagnostic testing performed including lab results and imaging exams. All imaging exams transferred to CD whenever possible. NIH stroke scale documentation to assess improvement or decline upon arrival to UF. Time of symptom onset and source of this information. Contact information of family members. Cell phone if available. Pertinent elements of patient past medical history. Especially atrial fibrillation, warfarin therapy, congestive heart failure, prior strokes, prior intracerebral hemorrhage, recent surgeries or instrumentation, and trauma. Patient current medication. Brief documentation of ALL therapies initiated at your hospital. If IV tpa is excluded, please document rationale. In no circumstances should acquisition of these items delay the transfer of the patient. Urgent transfer minimizing time to presentation is an absolute priority.
Acute Stroke Triage, Treatment and Transfer Protocol Patient arrives in ED with neurologic findings Assess ABC s and vital signs, provide O2 if hypoxic, obtain IV access and draw blood for labs, order emergent imaging, obtain 12-lead ECG. Activate stroke team. Completed within 10 minutes of arrival. Immediate assessment by stroke team to include review of history, establish time of onset, and NIHSS. Completed within 25 minutes of arrival. Results of imaging exam and labs reviewed. Completed within 45 minutes of arrival.
Acute Stroke Triage, Treatment and Transfer Protocol Neurologic evaluation and CT/MRI consistent with ischemic stroke Neurologic evaluation and CT/MRI consistent with intracranial hemorrhage Review fibrinolytic exclusion/ inclusion criteria. Initiate therapy within 4.5 hours of symptom onset (within 60 minutes of hospital arrival). If question of diagnosis contact with either internal or remote pre-arranged expertise Contact receiving hospital (if neurosurgery not available on site) for transfer and arrange EMS If no onsite capability for management contact receiving hospital for transfer and arrange EMS If non-hemorrhagic stroke diagnosis utilize thrombolytic protocol Receiving hospital communicates with transferring hospital regarding status Receiving hospital communicates with transferring hospital regarding status Contact receiving hospital for transfer if needed based on previous contact Receiving hospital communicates with transferring hospital regarding status