BCMCH-ED-FORM 002 DOOR TO NEEDLE TIME IN STROKE PATIENTS

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date

YYYY

Emp ID of Staff *

UHID *

Time of Arrival *

Time

DEMOGRAPHIC DETAILS *

Yes

Name

Age

Gender

UHID

Signs and Symptoms of Stroke (BEFAST) *

Yes

Partial

Giddiness

Balance of Gait

Eye Vision / Blurred Vision

Facial deviation

History of Fall

Slurring of Speech

Difficulty in swallowing

Left sided weakness

Right sided weakness

Aphasia

Disoriented

Decreased Response

Found on the floor

Generalized Weakness

Unconscious

Right arm weakness

left arm weakness

Upper Limb weakness

Lower limb weakness

Headache

Vomiting

Difficulty in walking

Seizure

CO-MORBIDITIES *

Yes

Partial

ACS

CAD

OLD CVA

HTN

CKD

DLP

Allergies

PTCA

COPD

Urecemia

Hypothyroidism

S/P CABG

CLD

TIA

Seizure Disorder

Parkinsonism

BPH

Psychiatric illness

WITHIN WINDOW PERIOD *

ONSET DURATION *

STROKE CODE ANNOUNCED *

STROKE CODE ANNOUNCED TIME *

Time

STROKE NURSE PRESENT *

VITAL SIGNS *

Yes

TPR

GRBS

GCS

EWS

GCS SCORE *

EWS SCORE *

IV Canulation *

Time

CT *

CT TIME *

MRI *

MRI TIME *

Time

DIAGNOSIS *

NIHSS SCORE *

THROMBOLYTIC THERAPY INDICATED *

BLOOD PRESSURE MONITORED *

IF BP more than 185/110 Labetalol Started *

Labetalol Dose *

Yes

5mg

10 mg

20 mg

40 mg

Amlodipine 5 mg

Cilacar 10 mg

CONSENT TAKEN FOR THROMBOLYTIC THERAPY *

THROMBOLYTIC ADMINISTERED *

THROMBOLYTIC ADMINISTERED BOLUS TIME *

THROMBOLYTIC ADMINISTERED INFUSION *

THROMBOLYTIC TYPE *

Alteplase

Reteplase

Tenecteplase

Streptokinase

Required

THROMBOLYTIC DOSE *

BLOOD PRESSURE MONITORED every 15 minutes for 1 hour, then 30 minutes in one hour and 1 hourly till Patient is shifted to NHDU
*

ADVERSE EVENT
*

MECHANICAL THROMBECTOMY INDICATED *

Yes

Required

CRANIECTOMY INDICATED *

Yes

Required

PATIENT SHIFTED TO *

MECHANICAL THROMBECTOMY TIME *

DOOR TO NEEDLE TIME *

DOOR TO CT TIME *

DOOR TO MRI TIME *

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