Ryan showed excellent judgment, attention to detail and team focus in the care of a patient today. In the midst of a busy shift, a patient arrived who was triaged from EMS as having a pre-syncopal episode with lightheadedness. While I was occupied with another patient, Ryan performed his own history, recognized that the patient was voicing neurologic symptoms, and performed an NIHSS assessment picking up a very subtle neurologic deficit (a left upper quadrant visual field deficit). He immediately found me in the ED, I confirmed the findings on my own exam and we called a Hot Stroke. The patient received tenectaplase within the window with significant improvement in his visual symptoms. I think there are many doctors, myself included who would have missed such a subtle neurologic finding with an unrelated triage assessment/EMS report. I certainly would not have recognized it within the window for thrombolytic without Ryan. What an amazing nurse.