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2 Minute EBP Challenge

Tuesday, May 15, 2012
Consequences of Patients Leaving AMA
About 500,000 patients per year leave the hospital against medical advice (AMA). Patients who leave AMA:

Monday, May 07, 2012
Cardiovascular Mortality and COX-2 Inhibitors
The anti-inflammatory drug class COX-2 inhibitors increase cardiovascular mortality due to what mechanism?

Monday, April 30, 2012
Nursing Excellence and Outcomes
Recognition of nursing excellence (RNE) is a program developed by the American Nurses Credentialing Center (ANCC) to recognize extraordinary nursing care. Hospitals with this designation have which characteristics?

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  • Get tips, timesavers, and more from
    David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN

    Home > 2 Minute EBP Challenge > Treatment of "Wake Up" Stroke

    Treatment of "Wake Up" Stroke

    Monday, February 13, 2012
    2 Minute EBP CHallenge

    Stay up-to-date the easy way!

    How would you answer this question?

    In up to 25% of patients with stroke the onset time is unknown. If the patient woke up with ischemic stroke symptoms, what would be the most appropriate treatment?

    a.  Supportive treatment with oxygen therapy only.
    b.  Oxygen therapy and anticoagulation.
    c.  Oxygen, anticoagulation, and blood pressure control.
    d.      Oxygen, anticoagulation, blood pressure control, and thrombolysis with tPA.

    The correct answer is "d" oxygen,     anticoagulation, blood pressure control, and thrombolysis with tPA.

    The "wake up" stroke occurs when a patient is asymptomatic when going to sleep, but wakes up with stroke symptoms. In the past, the American Heart Association (AHA) recommended that "wake up" stroke be treated as if the stroke occurred shortly after the last time the patient was seen without symptoms. If the patient went to bed at 11PM it was assumed that the stroke happened at 11PM and thrombolytics were contraindicated if the patient woke 4.5 hours later.

    Preliminary data suggest that patients with "wake up" stroke have better outcomes when treated with thrombolytics, despite uncertainty about the time of onset. Some researchers suggest that strokes are more likely to occur at the end of the sleep cycle, therefore damage is recent when the patient wakes up.

    Stroke treatment is evolving and it is important to consider patients individually when deciding on treatment options. Thrombolysis has been associated with improvement in mortality, morbidity, and neurological recovery and should be considered for patients with "wake up" stroke.

    From: Manawadu, D., et al. (2012). Thrombolysis in selected patients with wake-up stroke is feasible with similar safety as thrombolysis in 0 to 4.5 hours. ASA 2012; Abstract 56.

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    Best wishes,
    David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN
    President,     Ed4Nurses, Inc.

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