The SimKit Podcast Stroking Out in the Community with Evie Marcolini
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Dec 2, 2024 
In this discussion, Dr. Evie Marcolini, an emergency medicine and neurocritical care physician, sheds light on the intricate world of stroke management in community hospitals. She shares insights on the advancements in stroke care, including endovascular therapies like mechanical thrombectomy. Dr. Marcolini also delves into the complexities of administering TPA, emphasizing collaboration with neurologists. She highlights the significance of the NIH Stroke Scale in treatment decisions and reinforces the importance of patient education for informed consent in stroke management.
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Initial Stroke Assessment
- Conduct a focused neurological exam, not a full NIHSS, upon patient arrival to assess for large vessel occlusion (LVO).
- Prioritize rapid CT scan and basic labs (e.g., finger stick glucose) to rule out bleeding and assess eligibility for thrombolysis.
Streamlining Stroke Care
- Use pre-arrival stroke alerts to prepare CT and streamline the process.
- Consider pre-mixing TPA to save time if your system allows for it.
Thrombolysis Consent and Consultation
- Obtain consent for thrombolysis whenever possible, as it is a procedure with risks.
- Involve neurology for consultation, especially in complex or borderline cases.