Get ready for a series of rapid-fire presentations that promise to be informative, entertaining, and thought-provoking!
In this event, seven speakers will each have six minutes to captivate you with their ideas and stories.
1. Stroke and a Coffee: Saskatoon Stroke Program Provincial Stroke Rounds (Ruth Whelan)
Background: Guided by the Hub and Spoke model, Saskatoon, Saskatchewan’s Royal University Hospital, serves as the provinces comprehensive stroke center serving 8 primary stroke centers. Throughout 2022-2023, the Saskatoon Stroke Program (SSP) reconnected with primary stroke centers across the province. An emergent theme was the desire for enhanced stroke care knowledge among spoke centres.
Method: A pilot project was created by the SSP with support from the, University of Saskatchewan and the Saskatchewan Health Research Foundation. The aim was to support health care providers (HCP) participating in stroke care via a monthly virtual case-based round. Participants were invited to complete pre and post sessions surveys, allowing facilitators to focus content on identified knowledge gaps. Sessions were guided by evidence-based practice.
Results: Engagement was high as was reflected in the sustained number of live and recorded views of each sessions. 344 individuals registered to participate, consisting of multiple types of HCP and broad provincial representation, 28% of whom provided care in primary stroke centers. Average attendance of live viewership was 128 individuals. Average views of recorded session was 83 individuals.
Discussion: The need for evidence and expert based knowledge to support HCP in the delivery of stroke care was clearly demonstrated by the successful implementation of this pilot project. Feedback from participants spoke to knowledge gained from participation while a secondary outcome was building a stronger stroke community. Participants reported feeling grateful for this unique opportunity to learn while connecting with HCP also providing care across the stroke continuum.
2. Vasospasm and Delayed Cerebral Ischemia in the Aneurysmal Subarachnoid Hemorrhage Patient (Philippe Gallant)
Aneurysmal subarachnoid hemorrhage is an important source of death and disability worldwide (Etmian, et al. 2019). Following initial cerebral injury, these patients often suffer many complications, including cerebral vasospasm (Hickey & Strayer, 2020; Paul, et al. 2016). Given the high rate of cerebral vasospasm of 70% and its potentially devastating outcomes, it is incumbent on the neuro nurse to grasp the complex pathophysiology behind cerebral vasospasm, how it can contribute to delayed cerebral ischemia, and how it should be identified and managed (Paul, et al. 2016). Through a literature review, I identify recent changes in practice, and possible future therapies. These changes include the abandoning of so called “triple H therapy”, in favour a modified strategy of targeting euvolemia, allowing patient to maintain their own blood pressure and only intervening when symptomatic of hypotension, and avoiding hemodilution (Burns et al. 2018; Findlay et al. 2016; Young Lee et al.2013). I explore future therapies, including the more widespread use of IR interventions which thus far have had limited implementation, statin therapy, magnesium therapy and endothelin-1 antagonists (Burns et al. 2010; Findlay et al. 2016; Neligan & Deutschman, 2020). These changes to current standards, as well as changing radiological techniques, help reduce the burden of delayed cerebral ischemia, and directly effect the neuro nurse’s practice. Keen, detailed and reproducible neurologic exams help to corelate potential areas of vasospasm with clinical finding. Such exams inform treatment by excluding other possible causes for neurological change, before treatment for vasospasm can commence.
3. Autonomic Nervous System Dysfunction in Pediatric Concussion: A Scoping Review (Scott Ramsay)
Background: Concussions are a significant health issue for children and youth, with the potential for consequences in multiple domains of health. Dysfunction of the autonomic nervous system (ANS) has been proposed as a contributing factor to concussion symptoms given its role in regulating cerebral perfusion. However, the influence of autonomic dysfunction is largely undetermined after pediatric concussion, therefore we sought to identify and summarize the relationship between autonomic dysfunction and pediatric concussion.
Methods: We searched Medline, Embase, CINAHL, Web of Science, PsycInfo, and Scopus for articles relating to the following concepts: concussion, autonomic dysfunction, and children/youth. Two independent reviewers screened and evaluated articles and extracted data including study participants, methods, and results. Data regarding autonomic dysfunction, autonomic measurement, and stage of injury are reported.
Results: Of the 76 studies initially identified, 11 met inclusion criteria. Ten of 11 studies identified ANS dysfunction after concussion in the pediatric population. All studies used cardioregulatory function measures, with two studies also including carbon dioxide levels to identify autonomic dysfunction. Participant outcomes included abnormalities in heart rate variability, orthostatic hypotension, dizziness, and carbon dioxide levels. There was no distinct time when ANS measurements occurred (six studies in the acute phase, six studies in the subacute phase, and four chronically) and only three studies provided an intervention (i.e., exercise).
Conclusion: Autonomic Dysfunction appears commonly after a pediatric concussion. Cardioregulatory function is the preferred measurement technique. Lastly, neuroscience nurses must be aware of the physiological differences after pediatric concussion to provide appropriate symptom management and interventions.
