Acute Stroke on the Ward

Scenario:
Acute Stroke on the Ward
Contributed by ALIM NAGJI on January 01, 2021, last updated on May 13, 2021.
Language:
English
Author(s):
  • First Name: 
    ALIM
    Last Name: 
    NAGJI
    Credentials/degrees: 
    MD CCFP-EM DRCPSC (Clin.Ed.)
    Organization: 
    McMaster University / Joseph Brant Hospital
  • First Name: 
    Anum
    Last Name: 
    Haroon
    Credentials/degrees: 
    MD CCFP
    Organization: 
    Oakville-Trafalgar Memorial Hospital

Goals & Objectives

Brief Summary of Case:

A 74 year old female is admitted under the hospitalist at a community hospital with a UTI. She is on day 3 of antibiotic therapy. While in hospital, she develops acute onset of right arm weakness, facial droop and unintelligible speech. Participants should recognize an acute CVA within the window, perform a stroke assessment, treat hypertension and administer TPA and consider thrombectomy.  

This case can be performed by hospitalists, internists, intensivists or in situations where ED doctors are called to the floor. The time of day can also be modified to after hours to emphasize how local protocols may differ at various points of the day. In this case, no in hospital neurologist is available and the hospital is not a stroke centre. 

Learning Objectives:
  1. Identify and activate the Code Stroke (Teal) protocol for an acute stroke within the window
  2. Perform a National Institute of Health Stroke Scale
  3. Demonstrate understanding of indications and contraindications for the administration of recombinant tissue plasminogen activator (TPA)
  4. Recognize different imaging modalities for stroke diagnosis and demonstrate knowledge of indications for mechanical thrombectomy

Details

Setting:
Critical care unit, Emergency room, Hospital ward
Simulation modality:
Manikin (mid/low sophistication), Role-playing
Equipment:
TPA contraindications check list Glucometer IV lines Oxygen mannekin or actor
Keywords:
cerebrovascular accident, TPA, stroke, hypertensive emergency
Evaluation/validation:

This scenario was created as a collaboration between Joseph Brant Hospital and Oakville-Trafalgar Memorial Hospital, two community hospitals that deal with stroke patients on wards. In community sites, a number of different specialties may be responsible for acute stroke activations which can take place in the ED, on a medical ward or in the Intensive care unit. This scenario was piloted with a group of hospitalists to pilot a new code stroke protocol and review advances in mechanical thrombectomy including regional referral practices. 

8 hospitalists participated in the sim and feedback on the scenario was integrated into the case design. 

Peer Review Status:
None

Sharing

CITATION

NAGJI 
A
 Acute Stroke on the Ward. Simulation resource published by Simulation Canada; 2021. Available from http://www.sim-one.ca/scenario/acute-stroke-ward.
Haroon 
A
 Acute Stroke on the Ward. Simulation resource published by Simulation Canada; 2021. Available from http://www.sim-one.ca/scenario/acute-stroke-ward.
License: Download and use of this resource is subject to these terms.
Authors interested in research collaboration?
No
What type of resource do you want to submit?: 
Scenario
How would you like to submit your resource?: 
I will upload files
Your Title: 
Director, Simulation Learning Joseph Brant Hospital
Language: 
English
Author(s): 
First Name: 
ALIM
Last Name: 
NAGJI
Credentials/degrees: 
MD CCFP-EM DRCPSC (Clin.Ed.)
Organization: 
McMaster University / Joseph Brant Hospital
First Name: 
Anum
Last Name: 
Haroon
Credentials/degrees: 
MD CCFP
Organization: 
Oakville-Trafalgar Memorial Hospital
Authored Date: 
Friday, November 13, 2020
Interprofessional: 
No
Target learners: Profession(s): 
  • Medicine
Target learners: Level(s): 
Undergraduate / post-secondary
Graduate / postgraduate / residency
Continuing professional development
Healthcare field(s): 
Critical care
Emergency / trauma
Medical
Brief Summary: 

A 74 year old female is admitted under the hospitalist at a community hospital with a UTI. She is on day 3 of antibiotic therapy. While in hospital, she develops acute onset of right arm weakness, facial droop and unintelligible speech. Participants should recognize an acute CVA within the window, perform a stroke assessment, treat hypertension and administer TPA and consider thrombectomy.  

This case can be performed by hospitalists, internists, intensivists or in situations where ED doctors are called to the floor. The time of day can also be modified to after hours to emphasize how local protocols may differ at various points of the day. In this case, no in hospital neurologist is available and the hospital is not a stroke centre. 

Simulation modality(ies): 
  • Manikin (mid/low sophistication)
  • Role-playing
Minimum: 
1
Maximum: 
3
Equipment: 
TPA contraindications check list Glucometer IV lines Oxygen mannekin or actor
Pilot Testing / Revisions: 

This scenario was created as a collaboration between Joseph Brant Hospital and Oakville-Trafalgar Memorial Hospital, two community hospitals that deal with stroke patients on wards. In community sites, a number of different specialties may be responsible for acute stroke activations which can take place in the ED, on a medical ward or in the Intensive care unit. This scenario was piloted with a group of hospitalists to pilot a new code stroke protocol and review advances in mechanical thrombectomy including regional referral practices. 

8 hospitalists participated in the sim and feedback on the scenario was integrated into the case design. 

Development time: 
10
Research Collaboration: 
No
Peer Review: 
No
Setting: 
Critical care unit
Emergency room
Hospital ward
Keywords: 
cerebrovascular accident, TPA, stroke, hypertensive emergency
Learning Objectives: 
  1. Identify and activate the Code Stroke (Teal) protocol for an acute stroke within the window
  2. Perform a National Institute of Health Stroke Scale
  3. Demonstrate understanding of indications and contraindications for the administration of recombinant tissue plasminogen activator (TPA)
  4. Recognize different imaging modalities for stroke diagnosis and demonstrate knowledge of indications for mechanical thrombectomy