Tag Archives: UHS WMH

Stroke Core Measures

1.  VTE prophylaxis

[YES] VTE prophylaxis was provided with TED stockings and sequential compression devices on the day of admission.  

[NO] Pharmacologic VTE prophylaxis was not initiated becuase patient had a hemorrhagic stroke.

2.  Antithrombotic Therapy

[YES] This patient presented with ischemic stroke, and is discharged on antithrombotic therapy with [aspirin, Plavix].

Antithrombotic Therapy by the end of Day 2

[YES] Antithrombotic therapy with [aspirin, Plavix] was administered by the end of hospital day 2.

3.  Anticoagulation Therapy

[YES] Etiology of stroke for this patient is most likely due to cardioembolic event [atrial fibrillation].  Anticoagulation therapy with [coumadin, Xarelto, Pradaxa, Eliquis] has been  prescribed at discharge to prevent recurrent ischemic stroke. [Coumadin reduces the relative risk of thromboembolic stroke by 68%.]

[NO] Anticoagulation therapy is not indicated in this patient.


Thrombolytic Therapy

[YES]  Intravenous TPA was administered to this patient with acute ischemic stroke within 3 hours of symptom onset based on the evidence provided by the NINDS Studies [part 1 and 2].

[NO] Intravenous TPA was not given to this patient because the patient presented to the emergency department greater than 2 hours from the time he was last known to be well, and will not fall within the 3-hour window period for TPA administration.

[NO]  Intravenous TPA was not given to this patient because of the following contraindication/s:  ___.

4.  Statin Medication

[YES]  Lipid profile was measured within 48 hours of admission. [Lipid profile was available from within th epast 30 days].  LDL in this patient measured more than 100 mg/dL [or is less than 100mg/dL while on statins] and he/she is prescribed statin medication [atorvastatin] at hospital discharge based on the SPARCL study which demonstrated that the use of statin was associated with dramatic reduction in the rate of recurrent ischemic stroke.

5.  Stroke Education

[YES] Patient and/or the caregivers were given educational materials during the hospital stay addressing activation of EMS, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke.

6.  Assessed for Rehabilitation

[YES]  Patient was assessed for rehabilitation services by the physical and occupational therapists to prevent complications, minimize impairments, and maximize his function.


UHS Wilson Memorial Hospital Local Antibiogram

WMH Reference Card

Discharge Summary Dictation

H&P Dictation

Medical Education

Telephone Directory

House Staff Directory


Vital signs as follows: BP HR RR Temp sats
General: awake, not in distress
Heart: normal S1 S2, no MRG, NRRR, peripheral pulses 2+ bilaterally, no edema
Lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi, no accessory muscle use
Abdomen: soft, nontender, nondistended, bowel sounds normal, no palpable masses
Mental Status, patient is awake, alert, oriented to person place and time, normal affect;  Attention, can spell WORLD backwards, good attention span; speech is fluent without paraphasic errors, able to repeat, name objects, read and write; memory is good, calculation is good, no left-right confusion; Praxis: able to mimic blowing out match with either hand.
Cranial nerve exam:  II, III pupils equal and briskly reactive to light; visual acuity, visual fields full by confrontation, III IV VI EOM intact without nystagmus, no ptosis; V sensation intact to light touch, masseters strong symmetrically, VII face symmetric without weakness; VIII hearing grossly intact; IX X palate elevates symmetrically XI good shrug XII tongue protrudes midline, no atrophy or fasciculation.
DTRs: normoreflexive – bilateral biceps, brachioradialis, patellar and Achilles reflexes
MMT, strength is 5/5 on all 4s.  Sensory testing intact to light touch, pinprick, temperature, vibration and joint position intact.  No evidence of extinction.  Coordination: able to do rapid alt and point-to-point movements.  
Gait posture, stance, stride and arm swing normal.
If no tPA given, why?
If Afib – on AC? If no AC, reason / plan
Meds listed out
Lipid panel, A1C Carotids (Doppler, CTA, angio), Echo
On statin, if not, why?
ASA & PLavix
PT/OT, if no PT/OT why?
Modified Rankin Scale