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Acute Stroke Practice Test

Approximately what percentage of strokes are ischemic in nature, and thus eligible for fibrinolytic therapy if the patient qualifies? 80 70 60 50 Ischemic strokes account for 87% of all strokes and are usually caused by an occlusion of an artery to a region of the brain. AHA Advanced Cardiovascular Life Support Provider Manual, p. 74 The first critical decision point in the suspected stroke algorithm is? Consideration of fibrinolytic therapy General assessment and stabilization of the patient Performance and assessment of a non-contrast CT to differentiate between hemorrhagic and ischemic stroke Review of risks and benefits of fibrinolytic therapy with patient and/or family The performance and assessment of a non-contrast CT to differentiate between hemorrhagic and ischemic stroke is the critical decision point in the algorithm. The presence of hemorrhage versus no hemorrhage determines the next steps in treatment. AHA Advanced Cardiovascular Life Support Provider Manual, p. 73,76-77 Which of the following would exclude the use of fibrinolytic therapy in a patient confirmed to have had an ischemic stroke? Elevated blood pressure (systolic >160 or diastolic >90 mmHg) Current use of an anticoagulant Head trauma within the previous 3 months Seizure at the onset of stroke Exclusion criteria for fibrinolytic therapy include:
  • Significant head trauma or prior stroke in the previous 3 months
  • Symptoms suggest subarachnoid hemorrhage
  • Arterial puncture at noncompressible site in previous 7 days
  • History of previous intracranial hemorrhage
  • Elevated blood pressure (systolic greater than 185 mm Hg or diastolic greater than 110 mm Hg)
  • Active internal bleeding
  • Acute bleeding diathesis
  • Blood glucose concentration less than 50 mg/dL (2.7 mmol/L)
  • CT demonstrates multilobar infarction (hypodensity greater than 1/3 cerebral hemisphere)
AHA Advanced Cardiovascular Life Support Provider Manual, p. 86
Signs of possible stroke may include: Sudden severe headache with no known cause Sudden trouble walking Trouble speaking or understanding All of these The signs and symptoms of a stroke may be subtle. They include:
  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion
  • Trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking
  • Dizziness or loss of balance and coordination
  • Sudden severe headache with no known cause
AHA Advanced Cardiovascular Life Support Provider Manual, p. 78-80
If the patient woke from sleep with symptoms of stroke, when is time zero? The time the patient woke up The time the patient went to sleep When the patient was last seen to be acting normal Determined by if the patient has any health problems that could be contributing factors If the patient wakes from sleep with symptoms of stroke, time zero is the last time the patient was seen to be normal. AHA Advanced Cardiovascular Life Support Provider Manual, p. 74-78, 81, 83 Out-of-hospital acute stroke care focuses on: Initiation of the stroke pathway and patient admission to a stroke unit if available Ability to rapidly determine patient eligibility for fibrinolytic therapy Consideration of new treatment options Rapid transport to a facility capable of providing acute stroke care Out-of-hospital acute stroke care focuses on:
  • Rapid identification and assessment of patients with a stroke
  • Rapid transport (with pre-arrival notification) to a facility capable of providing acute stroke care
AHA Advanced Cardiovascular Life Support Provider Manual, p. 81
The 8 D's of Stroke Care include: Dispatch, Delivery, Death Door, Data, Defibrillation Detection, Dispatch, Dopamine Detection, Decision, Drug The 8 D's of Stroke Care are:
  • Detection: Rapid recognition of stroke symptoms
  • Dispatch: Early activation and dispatch of EMS by 911
  • Delivery: Rapid EMS identification, management and transport
  • Door: Appropriate triage to stroke center
  • Data: Rapid triage, evaluation, and management within the ED
  • Decision: Stroke expertise and therapy selection
  • Drug/Device: Fibrinolytic or endovascular therapy
  • Disposition: Rapid admission to the stroke unit of critical care unit
AHA Advanced Cardiovascular Life Support Provider Manual, p. 75
Fibrinolytic therapy should be initiated within how many hours of syptom onset? 3 8 1 12 Fibrinolytic therapy should be provided to eligible patients within 3 hours of symptom onset and 1 hour of hospital arrival. Door-to-admission time should be 3 hours. AHA Advanced Cardiovascular Life Support Provider Manual, p. 86 The Cincinnati Prehospital Stroke Scale identifies stroke based on which of the following three findings? Abnormal speech, abnormal gait and facial droop Arm drift, abnormal gait and abnormal speech One-sided weakness, facial droop and arm drift Facial droop, arm drift and abnormal speech The CPSS identifies stroke on the basis of 3 physical findings:
  • Facial droop (Have the patient smile or try to show teeth)
  • Arm drift (Have the patient close eyes and hold both arms up, with both palms up)
  • Abnormal speech (Have the patient say, "You can't teach an old dog new tricks")
AHA Advanced Cardiovascular Life Support Provider Manual, p. 78-80
Time zero is: The time when the patient was last known to be normal The time when the patient enters the ED (emergency department) The time when EMS is dispatched to see the patient The time when the patient is first assessed by the stroke team Time zero is when the patient was last known to be normal (i.e. symptom-free). If the patient wakes from sleep with stroke symptoms, time zero is the last time anyone saw the patient normal. AHA Advanced Cardiovascular Life Support Provider Manual, p. 81