<p>BAPTIST HEALTH LOUISVILLE EMERGENCY DEPARTMENT POST - tPA FLOWSHEET FOR STROKE / PE VS & Neuro checks: Q15 mins for 2 hrs after start of infusion and X2hrs after infusion; Q30 mins X6hrs, Q1hr X 16 hrs</p><p>Init Q15 Q15 Q15 Q15 Q15 Q15 Q15 Q15 Q30 Q30 Q30 Q30 Q30 Q30 TIME A = Alert Level of V = Verbal Consciousness P = Responds to pain U = Unresponsive Questions: 0 = Answers both correctly Month 1 = Answers 1 correctly 2 = Both incorrect Patient’s age Commands: 0 = Performs both correctly Open/close eyes 1 = Performs one correctly 2 = Both incorrect Grip/release hands N = Normal; equal # of teeth on both sides when Facial Droop smiling R = Right facial droop L = Left facial droop N = Normal; recognizes finger movements in all 4 quadrants Visual Fields R = Right visual field deficit L = Left visual field deficit N = No deficit: follows finger to left & right Horizontal Gaze R = Right gaze preference L = Left gaze preference Raised arms (palms up) do not drift down: Motor Arm-arm drift N = No drift or (eyes closed) test both arms Designate arm with deficit: together RA = Right arm LA = Left arm Each raised leg does not drift down: Motor Leg (eyes open) test N = No drift or Designate leg with deficit: individually RL = Right leg LL = Left leg N = Feels light pinch normally or Sensory-Arm & Leg Designate limb with deficit: (eyes closed) RA = Right arm; LA = Left arm RL = Right leg; LL = Left leg Speech: Have pt say: N = No wrong words, no slurring W = Wrong words “I am going to get better, no S = Slurring if’s, and’s or but’s about it” M = Mute Comparison to previous B = Better S = Same exam W = Worse Blood pressure</p><p>SpO2/Liters of 02</p><p>Heart Rate Y = yes Headache N = no</p><p>Initials</p><p>RN Signature/Initials: Date/Time Date/Time Date/Time </p><p>6300B6318 Revised 9/2009 OPTIO PAGE 1 of 2 POST – tPA FLOWSHEET FOR STROKE / PE VS & Neuro checks: Q15 mins for 2 hrs after start of infusion; Q30 mins X6hrs, Q1hr X 16 hrs</p><p>Q1 Q1 Q1 Q1 Q1 Q1 NIH TIME A = Alert Level of V = Verbal Consciousness P = Responds to pain U = Unresponsive Questions: 0 = Answers both correctly Month 1 = Answers 1 correctly 2 = Both incorrect Patient’s age Commands: 0 = Performs both correctly Open/close eyes 1 = Performs one correctly 2 = Both incorrect Grip/release hands N = Normal; equal # of teeth on both sides when Facial Droop smiling R = Right facial droop L = Left facial droop N = Normal; recognizes finger movements in all 4 quadrants Visual Fields R = Right visual field deficit L = Left visual field deficit N = No deficit: follows finger to left & right Horizontal Gaze R = Right gaze preference L = Left gaze preference Raised arms (palms up) do not drift down: Motor Arm-arm drift N = No drift or (eyes closed) test both arms Designate arm with deficit: together RA = Right arm LA = Left arm Each raised leg does not drift down: Motor Leg (eyes open) test N = No drift or Designate leg with deficit: individually RL = Right leg LL = Left leg N = Feels light pinch normally or ssSensory-Arm & Leg Designate limb with deficit: (eyes closed) RA = Right arm; LA = Left arm RL = Right leg; LL = Left leg Speech: Have pt say: N = No wrong words, no slurring W = Wrong words “I am going to get better, no S = Slurring if’s, and’s or but’s about it” M = Mute Comparison to previous B = Better S = Same exam W = Worse Blood pressure</p><p>Sp02/Liters of 02</p><p>Heart Rate Y = yes Headache N = no Initials</p><p>RN Signature/Initials: Date/Time  ED stroke orders complete & signed Date/Time  Thrombolytic for stroke education sheet signed/witnessed Date/Time  tPA orders complete & signed  NIH stroke scale documented prior to tPA administration</p><p>6300B6318 Revised 9/2015 vgg OPTIO PAGE 3 of 3</p>