O Olek Health
⚡ 0 XP
+10 XP
Interactive Pilot — 2026

Telestroke Assessment

Master rapid stroke recognition and remote nursing support

This isn't a lecture — it's hands-on practice. You'll recognize strokes, score severity, and make clinical decisions as you learn.

⏱ ~35 minutes · 4 modules · Earn XP as you go

⏱

Module 1

Stroke Fundamentals

📋

Module 2

NIHSS Scoring

🔗

Module 3

Telestroke Protocols

🏥

Module 4

Live Cases

⏱
Module 1

Time Is Brain

💡 The Numbers Matter

Every minute without blood flow, 1.9 million neurons die. Think of it like a city losing power — every second more of the grid goes dark permanently.

This is why "time is brain" is the stroke team mantra.

📊 The Facts

795,000 strokes per year in the United States

#5 leading cause of death in America

87% ischemic (blood clot), 13% hemorrhagic (bleeding)

American Heart Association, 2024

🏃 The Golden Hours

0–4.5 hours: tPA window. Ischemic stroke eligible for thrombolytic therapy.

0–24 hours: Mechanical thrombectomy window. Large vessel occlusions revascularized.

Door-to-needle goal: < 60 minutes for tPA

🚨 BE-FAST Warning Signs

B — Balance: Sudden loss of balance

E — Eyes: Sudden vision loss

F — Face: Facial drooping

A — Arms: Arm weakness or drift

S — Speech: Slurred speech

T — Time: Call 911. Note the time.

📈
Module 1

Ischemic vs Hemorrhagic

Tap each stage to learn more ↓

0–4.5 hours

Ischemic (Thrombotic)

Blood clot blocks artery. Brain tissue dies from lack of oxygen.

tPA window. 87% of strokes. Symptoms depend on location: weakness, speech changes, vision loss.
0–24 hours

Mechanical Thrombectomy

Interventional radiology removes clot via catheter.

For large vessel occlusions (LVO). Extends window: outcomes improve up to 24 hours in select cases.
Immediate

Hemorrhagic Stroke

Blood vessel ruptures. Blood pools in brain.

13% of strokes but deadlier. No thrombolytics. Focus on BP control and preventing rebleeding.
Key Difference

CT / MRI Distinguishes Type

You cannot tell ischemic from hemorrhagic by symptoms alone.

CT head is first: Quickly rules out hemorrhage before tPA. Get imaging fast, call the neurologist.

⚡ Match the Stroke Type

Hemorrhagic
Ischemic
Thrombectomy
tPA
87% of strokes. Clot-based.
0–4.5 hours window.
Vessel ruptures. No thrombolytics.
0–24 hours for LVO.
📋
Module 2

The NIHSS: Your Tool

🎯 What Is It?

The National Institutes of Health Stroke Scale — gold-standard bedside tool for measuring acute stroke severity.

15 domains · Max score: 42 · Takes 5–10 minutes

Brott et al., 1989 · Predicts outcomes and guides intervention

Why this matters

📊 Key Clinical Uses

Rapid severity assessment: Identifies LVO candidates

Standardized communication: Telestroke calls use NIHSS

Outcome prediction: NIHSS > 15 suggests LVO

🎯
Module 2

NIHSS Severity

0–4

No/Minor

Minimal deficits.

5–15

Moderate

Noticeable deficits.

16–20

Mod-Severe

Significant. LVO likely.

21–42

Severe

Massive. LVO certain.

Key Finding

📊 NIHSS ≥ 15 = LVO Signal

NIHSS ≥ 15 strongly suggests large vessel occlusion. These patients need rapid imaging and thrombectomy evaluation.

A patient has right arm weakness, mild facial droop, mild speech changes. NIHSS = 8. Your interpretation?
A Moderate stroke. Definite tPA candidate.
B Minor stroke. May be TIA-like.
C Severe stroke. LVO likely.
🩺
Module 2

NIHSS Simulator

Use the sliders to score. Watch severity update in real time.

68-year-old woman, sudden right arm weakness and slurred speech 2 hours ago.
HR 88
BP 162/94
O₂ 98%

1. LOC

Alert, awake, responds appropriately.
0

2. LOC Questions

Correctly answers month and age.
0

3. LOC Commands

Follows commands correctly.
0

4. Gaze

Eyes move equally left-right.
0

5. Visual Fields

Sees equally from all directions.
0

6. Facial Palsy

Mild asymmetry on left smile.
0

7. Motor Arm (Left)

Left arm drifts downward with effort.
0

8. Motor Leg (Left)

Left leg weak but maintains strength.
0

9. Limb Ataxia

Finger-nose test: no dysmetria.
0

10. Sensory

Feels pin prick equally bilaterally.
0

11. Language

Speech slurred. Names correctly. Comprehends.
0

12. Dysarthria

Slurred but intelligible.
0

13. Extinction

Perceives both sides equally.
0
0
Score the patient above
🔗
Module 3

The Telestroke Workflow

🏥 Your Role: Eyes & Hands

You are the remote neurologist's eyes and hands.

✓ Recognize stroke alert quickly

✓ Position camera for telestroke exam

✓ Have patient ready for NIHSS

✓ Relay vitals, glucose, last known well time

✓ Prepare for rapid medication or intervention

0–10 min

Stroke Alert + CT

Stat non-contrast CT head to rule out hemorrhage.

Before ANY drug is given, rule out bleeding. CT quickly differentiates ischemic from hemorrhagic. If blood is present, tPA is absolutely contraindicated.
10–20 min

Labs + Telestroke Consult

STAT CBC, CMP, coagulation, glucose.

Glucose is critical: hypoglycemia can mimic stroke. Coagulation determines tPA eligibility. Initiate telestroke consult while labs run.
20–30 min

tPA Decision

Neurologist reviews imaging, NIHSS, eligibility.

tPA: 0.9 mg/kg (max 90 mg). 10% IV bolus over 1 min, remainder over 60 min. Within 4.5 hours symptom onset. Check: recent surgery, active bleeding, high INR, low platelets.
If eligible

Thrombectomy Evaluation

NIHSS ≥ 6 + LVO imaging → IR.

Large vessel occlusions candidate for thrombectomy up to 24 hours in select cases. Time to recanalization = time saved for brain tissue.

🛡️ Blood Pressure Management

Before tPA: Target < 220/120 mmHg

If giving tPA: Target < 185/110 mmHg

After thrombectomy: Follow IR/neuro orders

🚨 Hemorrhagic Conversion Red Flags

🔴 Sudden worsening of neurologic status

🔴 Severe headache

🔴 Nausea/vomiting

🔴 Elevated BP or heart rate spike

🔴 Signs of increased ICP

If suspected: STAT CT, notify provider, ICU transfer

🛡️
Module 3

Nursing Essentials

⏱ Document Time

THE most important detail.

✓ Last known well time (when was patient definitely normal?)

✓ Witnessed onset vs. wake-up stroke

✓ Wake-up stroke = use woke-up time; may allow thrombectomy

🏥 Your Bedside Checklist

✅ Continuous cardiac telemetry during tPA

✅ Frequent neuro checks: q15 min during infusion

✅ NPO until swallow screen passed

✅ Keep IV access patent

✅ Blood pressure monitoring per protocol

✅ Glucose monitoring: maintain 100–180 mg/dL

✅ Position: head of bed 30°

✅ Seizure precautions

✅ Fall risk interventions

✅ Urinary catheter only if unsafe to toilet

Patient receives tPA at 2:30 PM. At 3:15 PM, left arm is slightly weaker. What's your first action?
A Continue observing. Slight fluctuations are normal.
B STAT notify provider and get CT head to rule out hemorrhage.
C Stop the tPA infusion and wait for orders.
🏥
Module 4

Case A: Moderate

Patricia Chen, 68 y/o — Found on floor. Right-sided weakness and slurred speech. Last known well: 2 hours ago.
HR 92
BP 158/88
Glucose 124
CT No bleed

Your NIHSS: Total 6 (Mild-Moderate)

NIHSS 6, 2 hours from onset, no hemorrhage. What's your next step?
A She's mild. Observe and recheck in 1 hour.
B Within tPA window. Prepare for potential thrombolysis.
C NIHSS 6 suggests LVO. Call for thrombectomy.
During tPA infusion, her speech sounds clearer. What does this mean?
A The tPA is working! The clot is dissolving.
B Good sign of response. Continue infusion and monitor.
C Stop the infusion — she doesn't need it.
🚨
Module 4

Case B: Large Vessel

James Rodriguez, 55 y/o — Acute onset global aphasia, right gaze deviation, complete right hemiplegia. Onset: 45 minutes ago.
HR 104
BP 178/102
Glucose 198
CT No bleed

Your NIHSS: Total 26 (Severe)

🚨 Red Flags for LVO

Gaze deviation + severe motor + aphasia = LVO

Needs BOTH tPA AND thrombectomy evaluation.

NIHSS 26, 45 min from onset, no hemorrhage. This is a medical emergency. What's your priority?
A Wait for full labs. Start supportive care.
B Activate stroke alert. Prepare for tPA. Notify IR. This patient is a thrombectomy candidate.
C NIHSS 26 is too severe. tPA likely won't help.
Patient receives tPA at 1:30 PM. CTA shows left MCA occlusion (LVO). IR is ready. What now?
A Thrombectomy can wait 24 hours. Patient is stable.
B Prepare for immediate transfer to IR. The window is NOW. Every minute = brain loss.
C Thrombectomy is only outside the tPA window.
✅
Final Assessment

8-Question Check

1. How many neurons die per minute of stroke?
A 100,000
B 1.9 million
C 500,000
2. What does NIHSS ≥ 15 suggest?
A Complete recovery assured
B Large vessel occlusion (LVO) likely
C Hemorrhagic stroke certain
3. Door-to-needle goal for tPA?
A < 2 hours
B < 120 minutes
C < 60 minutes
4. Maximum dose of tPA for ischemic stroke?
A 60 mg total
B 90 mg total (0.9 mg/kg)
C 150 mg total
5. During tPA infusion, patient's symptoms worsen. Your first action?
A Increase the infusion rate
B STAT notify provider and get CT head
C Stop the infusion and give benzodiazepines
6. Which is a contraindication to tPA?
A Recent dental work
B On apixaban (anticoagulant)
C Mild headache
7. Window for mechanical thrombectomy?
A 0–4.5 hours only
B Up to 24 hours in select LVO cases
C Never — only for hemorrhagic strokes
8. Gaze deviation, global aphasia, right hemiplegia (NIHSS 25). Onset 90 min ago. Your move?
A Comfort care only. Too severe.
B Activate stroke alert. Prepare for tPA and thrombectomy. This patient is a candidate.
C Observe and recheck neuro in 4 hours.
🎓

Course Complete!

You earned 0 XP. Excellent work.

📋 Competencies Mastered

✓ Recognize acute stroke signs using BE-FAST

✓ Perform rapid NIHSS assessment

✓ Differentiate ischemic from hemorrhagic stroke

✓ Support telestroke consults

✓ Know tPA eligibility, dosing, monitoring

✓ Identify LVO candidates for thrombectomy

✓ Recognize and respond to hemorrhagic conversion

✓ Implement bedside nursing care during stroke intervention

📚 Key References

American Heart Association (2024). Guidelines for Early Management of Acute Ischemic Stroke.

Brott et al. (1989). Quantitative Assessment of Neurological Deficit. Stroke, 20(7).

Saver et al. (2016). Time is Brain. Stroke, 47(10).

Nogueira et al. (2018). Thrombectomy 6 to 24 Hours. NEJM, 378(1).

🚀 Next Steps

1. Complete a live NIHSS return demonstration

2. Shadow a telestroke consult

3. Review your facility's stroke alert protocol

4. Apply these skills at the bedside — rapid recognition saves brain

Olek Health Nursing Education · Telestroke Module 2026