After a code stroke resuscitation, the patient needs a monitored bed for neurologic monitoring.

On the B4 Stroke Unit, there will ultimately be several types of beds.

• Post-TPA ONLY - Level 1 (MRP = Orange Team) -these beds can provide every to every 2 hourly neuro vital signs, there is cardiac monitoring as well, there are no arterial lines, there are no infusions of vasoactive agents including pressors or infusions of labetalol, however certain medications requiring cardiac monitoring such as phenytoin, amiodarone can be provided.  Other medications can be given IV, but and intermittent dosing.

• Post-TPA and/or Post-EVT Level 2 (MRP = ICU) - these are equivalent to B5ICU beds, these patients can have vasoactive agents, have cardiac monitoring, and can have arterial lines, therefore if the patient requires infusion of vasoactive agents, which typically does require arterial line monitoring, these patients can go to this bed.

Definitions of ICU "levels":

Here's a breakdown of the care levels in our ICUs:

1. Level 1 Care (Lowest level of care): The primary responsibility lies with the Orange Team. This level of care includes neuromonitoring after Tissue Plasminogen Activator (TNK) administration, but no pressors or drips. The usage of Optiflow and Bilevel Positive Airway Pressure (BiPAP) are permitted for medical patients.

2. Level 2 Care (Intermediate level of care): The Critical Care Team is responsible at this level. In addition to neuromonitoring post-TNK, patients may also be post-Endovascular Treatment (EVT), on pressors, or drips. Use of Optiflow and BiPAP is allowed. However, in B4 Level 2, there's no Intracranial Pressure (ICP) monitoring or External Ventricular Drains (EVDs).

3. Level 3 Care (Highest level of care): The Critical Care Team also manages this level. All of the above procedures are allowed, in addition to ICP monitoring, EVDs, and intubation.

Regarding order writing:

• The Most Responsible Physician (MRP) team, i.e., the admitting or receiving team, writes the admission orders. For instance, the Orange Team writes the Level 1 admission orders. Conversely, the Critical Care team writes the admission orders for Level 2 and Level 3 care.

As for Stroke Team's role:

• The Stroke Team completes the "Critical Care: acute ischemic" order set. However, please be reminded that this does not override the necessity for the receiving team to fill out the appropriate Level 1, 2, or 3 admission orders.

• Let's continue to work together to ensure smooth transitions of care for our patients.