Name: Date:

Feedback Tool: STARUMA

Milestone Action Example Evidence of Behavior Clear Some No
and Level Evidence Evidence Evidence
PC1 1 Place patient on monitor
2 Recognizes concern for stroke* Obtains abbreviated history, rapid transport to CT
2 Rapidly obtains blood sugar Obtains within 0-3 minutes of arrival
2 Performs primary assessment of ABCD*
2 Recognizes change in mental status*
3 Addresses blood pressure prior to administration of tPA
3 Reassess patient following tPA administration
3 Discusses intubation with family member
4 Continuously reassesses patient Assesses patient more than 2 times during case
4 Request patient representative for family during decompensation
PC2 2 Reliable focused HPI Elicits onset, progression, vision changes, weakness
location, headache, seizure activity
2 Elicits past medical history Elicits history of stroke, past surgical history, meds
2 Performs focused physical exam Auscultates heart, lungs and performs neuro exam
3 Requests access to an NIH stroke scale resource
3 Performs NIH stroke scale appropriately* Identifies NIHSS = 10 +/-1
4 Elicits RELATIVE contraindications to tPA*
4 Elicits ABSOLUTE contraindications to tPA*
5 Calculates NIH stroke scale independent of outside resources*
PC3 2 Prioritizes obtaining a CT scan* Completes within 5 minutes
2 Orders CBC, BMP, INR and ECG
3 Recognizes normal CT does not exclude ischemic stroke
(family/nurse may ask if not apparent)
3 Discusses the risks/benefits of a tPA* States risk for ICH between 4-8% (6%)
3 Repeats CT scan following patient decompensation*
4 Considers “cost-effective” medicine Avoids unnecessary tests or “shot-gun” approach
PC4 2 Provides family member with possible diagnoses May be prompted
2 Identifies patient as “sick”
3 Excludes other stroke-like illnesses
4 Considers differential for change in mental status following tPA
PC5 1 Assesses drug allergies
2 Begins treatment with oxygen
3 Selects appropriate anti-hypertensive agent prior to tPA
 3 Administers tPA*
4 Treats elevated ICP*
PC7 2 Provides family patient education
3 Activates stroke team
3 Contacts neurologist in timely fashion
3 Contacts interventional radiology*
3 Admits patient to hospital*
4 Appropriate level of care chosen for admission*
PC10 2 Administrates appropriate RSI medications*
2 Confirms tube placement*
2 Verifies intubation equipment*
4 Identifies backup airway maneuver prior to intubation*
PROF1 1 Demonstrates a caring approach
2 Respects patient and session
PROF2 1 Reports on-time for simulation
ICS1 1 Establishes rapport
1 Listens to patient and family
2 Elicits reason for ED visit
3 Effectively speaks with patient/family
ICS2 2 Delivers clear nursing orders
3 Concisely presents patient to admitting physician
* Represents a critical action (Appendix F)
Considers mannitol, hyperventilation, head elevation
Discusses diagnosis, care plan
Requests bed in medical or neuro ICU
Obtains post-intubation CXR
Checks ETT balloon, laryngoscope light, suction
Request difficult airway adjunct(s)
Sits with patient or family
Receptive to case and debriefing education
Arrives on time, appropriate attire with stethoscope
Uses kind tone, avoids ignoring family when unstable
Avoids repeat questions
Avoids of medical jargon
Avoids confusing or multiple orders at one time
Presents with appropriate level of detail, includes
NIHSS, repeat CT with increased ICP