EMCrit FOAM Feed · Scott D. Weingart, MD FCCM

1:1 Nursing 008 – The Stroke Show

March 23, 2026·36 min·2 clips

Scott warns that leaving nicardipine at 15 can turn a controlled stroke blood pressure into a systolic of 50.

1. EMCrit FOAM Feed's 1:1 Nursing 008 covers stroke resuscitation nursing for ischemic and hemorrhagic presentations, including BFAST and tenecteplase workflows. 2. Scott Weingart hosts Candice, a stroke-resuscitation nursing leader who describes triage algorithms, direct-to-CT operations, and staff training at Stony Brook Hospital. 3. The core approach is to combine symptom timing, focused neurologic screening, and rapid imaging rather than treating every vague neurologic complaint as the same activation. 4. Candice's triage algorithm uses BFAST for possible large-vessel stroke and sends symptoms under 24 hours directly to CT, while resolved symptoms receive documented assessment rather than active activation. 5. Posterior-stroke screening includes standing, walking, Romberg testing, gait observation, leaning, wall collisions, and sudden visual changes. 6. Stony Brook's ambulance and walk-in workflows obtain last-known-well time, anticoagulant use, and blood pressure before direct-to-CT imaging, while neurology performs NIHSS in the scanner. 7. The team uses stretcher scales calibrated monthly or every six months, with daily zero checks, and generally does not wait for laboratory results before thrombolytic treatment when appropriate. 8. Scott warns that rapidly titrated nicardipine should be reduced toward 3 after reaching a systolic goal near 180, because leaving the infusion at 15 can cause profound hypotension. 9. Hemorrhagic-stroke management includes locked emergency-department PCC supplies, empiric reversal for anticoagulated patients, Q15-minute neurochecks after thrombolytics, and serious evaluation of post-treatment headache. 10. Emergency and critical-care nurses seeking practical stroke workflows.

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