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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.

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NORMAL SYSTEMIC PHYSICAL EXAMINATION
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
 
NORMAL NEURO DICTATION
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.
 
CORE MEASURES:
NIHSS in ED
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