Now, here's our goals
for Acute TIA treatment.
This is one of the nurses
that you'll meet in ER.
You'll see him throughout
our video series.
In the trauma emergency center,
the main goal is going to do
an initial neuro assessment
to history, exam,
and get them on cardiac monitoring.
So when that patient rolls in,
they go into triage,
the triage nurse recognizes this patient
needs to be seen very quickly.
The goal will be
an initial neuro assessment,
get their history,
examine the patient,
and get them on cardiac monitoring,
so we can keep an eye on them.
Also, start thinking
about other causes
of the neuro symptoms
that you're seeing
and what they're presenting with.
Now these patients are going to get moved
to the front of the line to get to imaging
because we're going to want
to take a picture of their brain.
So we're gonna go to CT or MRI.
We're trying to rule out that ischemic
or a hemorrhagic stroke.
Because when the patient starts
showing us these symptoms,
that's what we're worried about.
We want to make sure
they're not having an ischemic
or a hemorrhagic stroke.
So first test: CAT scan or MRI.
Now the neurovascular imaging:
MRA, CTA or TCD,
is something else that we'll do
to assess the arteries
as we continue to move
through this process.
We'll do a cardiovascular evaluation
and look if there's any cardio sources
of the emboli.
See, it's very common
for some type of clot
to break off from the heart
from inside the heart
and travel quickly up to the brain,
particularly if the patient
is in atrial fib.
Because, remember, an atrial fib,
that atrium instead of contracting fully,
it's kind of quivering, right?
It kind of does that.
And anytime that atrium
doesn't completely compress down
and squish all the blood out,
that blood ends up hanging out
in the right atrium.
And anywhere blood hangs out,
it coagulates and makes clog.
So, particularly, patients
who are in the heart rhythm
called atrial fibrillation,
that means that their atrium
isn't regularly contracting
and completely emptying,
there's an increase risk for clots
to come from that right atrium
and go all the way up to the brain.
We'll also do lab tests.
We'll try to rule out
some other metabolic
or other cause of the neuro symptoms
that we're seeing.
So as we're coming in the ER,
what's the first test
were likely going to do?
Right, we're going to do
a CAT scan or an MRI.
So first, we're going to notice
that the patient
has these neural problems
presented into triage.
They we're gonna recognize
that this person gets moved
to the front of the line, right?
They're going to do
a CAT scan or an MRI,
then the next test, we'll do look
at maybe an MRA, a CTA, a TCD.
We'll make sure we do a heart eval,
a cardiovascular evaluation to see
if that might be the source of a clot,
and we'll do lab tests to make sure
that we rule out metabolic
or other causes of these neuro symptoms.
Because remember that slide
with all the possible diagnoses
that could be on there,
it'd be nice if we just knew
exactly what it was
when a patient walks in the ER.
But that's part of the fun
of being an ER nurse,
it's like being an investigator,
you get all these clues
and you have to solve the mystery
of what's wrong with the patient.
So I want you to be in the frame of mind
that we're talking about a patient
that starts initially by showing us
some unusual neurological symptoms
and how would we walk them
right through the system
to evaluate and to see exactly
what we're dealing with.
So even with the TIA,
we want that patient to get to the ER
so they can have all these tests,
so we can see
what the next best step is.
Now, we've talked about these tests,
let's talk about them a little more.