Gerardo, many of us know him by G, is a night shift RN working on our stroke unit PCU 5W. He was taking care of a stroke patient who was being treated with thrombolytic therapy (IV-tPA), in addition to a mechanical thrombectomy for a large acute ischemic stroke at TMMC a little over a week prior. The patient was progressing well with an almost complete resolution of his symptoms prior to being transferred out of the ICU to PCU. While on PCU the patient was receiving the final medical work-up and was nearly cleared to be discharged to an acute rehab facility later that morning.
During G's patient rounding around 5:30 am he assisted the patient to the bathroom. As he got the patient back into bed G noticed an acute change in the patient's neurological condition. He was experiencing right-sided facial droop and increased right-sided weakness to the point where he could not lift his arm up off the bed. Immediately G alerted the rapid response RN of an acute change in the patient's neurological status. He was experiencing another acute ischemic stroke with a re-expression of his previous symptoms over a week prior.
The rapid response team arrived at the bedside and noted an NIH stroke scale score of 12 with severe right-sided deficits. The RRT activated the acute stroke protocol, alerted the neurologist, and the patient was swiftly taken for a stat CT angiogram of his brain. The CTA showed an acute re-occlusion in one of the patient's cerebral arteries.
Since the patient recently received IV thrombolytic therapy for his acute ischemic stroke he was not a candidate for the drug. However, he was deemed a candidate for another mechanical thrombectomy, and communication between G, the rapid response RN, and the neurologist expedited the process to get the patient down to the interventional radiology suite to perform the procedure. The patient had a successful procedure that morning and was discharged to an acute rehab facility a week later with a near resolution of his symptoms and an NIH stroke scale score of 2.
Because of G's alertness and recognition of the patient's acute change in the condition he was able to receive cutting edge stroke treatment that potentially saved him from lasting severe neurological deficits. "Time is Brain" and G acted swiftly in the best interest of the patient. I am extremely proud of G and the acute stroke response team's efforts that day!