What condition would exclude a patient from receiving alteplase?
Mild, nondisabling stroke
When comparing initial imaging and advanced imaging, what decision is always interpreted from initial imaging?
presence or absence of hemorrhage
When comparing initial imaging and advanced imaging, what decision is always interpreted from initial imaging?
what brain tissue is permanently damaged and what is at risk or salvageable - mismatch is good for salvage and match is bad to indicate no salvage
old infarcts - wrong
Refer to: Decision from Stroke Expertise/ Image Mismatch
What is the traditional time goal for initiation of noncontrast brain CT?
within 25 min
What complication should you immediately suspect if a patient develops sudden hypertension and acute neurological deterioration after reperfusion?
intracranial hemorrhage
When should EMS notify the receiving hospital of an incoming stroke patient?
prior to arrival
When should EMS notify the receiving hospital of an incoming stroke patient?
7
What assessment to measure deficits must be completed by the stroke team on all suspected stroke patients as soon as possible on arrival prior to treatment?
modified Rankin mRS - wrong
NIHSS - predicts lesion size, stroke severity, determines treatment, predicts outcome
Refer to: Data from Workup/Arrival Screening/ Severity Assessments
What is the recommended blood pressure before thrombolytic administration?
185/110
What action must an EMS dispatcher take when a caller describes symptoms of stroke?
talk caller through prehospital stroke screen
How frequently should blood pressure be monitored at a minimum in a patient who received a thrombolytic 12 hours earlier?
q1h
What diagnostic test is important for EMS to perform in suspected stroke patients to rule out conditions which may mimic stroke?
blood glucose test
How frequently should blood pressure be monitored at a minimum during the first 2 hours after thrombolytic administration?
q15m
How frequently should neuro assessments be performed at a minimum to monitor for intracranial hemorrhage during the first 2 hours after thrombolytic administration?
q15m
What assessment to measure prestroke disability must be completed by the stroke team when determining eligibility for mechanical thrombectomy?
ASPECTS score - wrong
mRS modified Rankin
Refer to: Data from Workup / Arrival Screening and Severity Assessments
What does advanced imaging with CTA/MRA provide?
detects occlusion or stenosis of large vessels of head and neck; identifies aneurysm, arteriovenous malformation, cerebral venous thrombus
IV thrombolytic eligibility - wrong
ASPECTS score - wrong
It assists w identifying Pts wo can be treated w mechanical thrombectomy, quantifying salvageable brain tissue, and pinpointing cause of hemorrhage.
Refer to: Decision from Stroke Expertise / Advanced Imaging
What is the symptom onset time frame (LKN) for thrombolytic eligibility?
4.5 hrs
What is a main goal of initial brain imaging (CT/MRI) in acute stroke?
rule out hemorrhage
What is the expanded symptom onset time frame for mechanical thrombectomy eligibility?
24 hrs
How frequently should neuro assessments be performed at a minimum to monitor for intracranial hemorrhage in a patient who received a thrombolytic 12 hours earlier?
every hour
When considering a patient for mechanical thrombectomy whose last known normal is greater than 6 hours, what condition would deem the patient ineligible?
severe disabling stroke - wrong
Incorrectly Answered: Severe disabling stroke
Refer to:
Drug-Device/ Mechanical Thrombectomy Eligibility
What is the EMS door-in to door-out time goal for hospital-to-hospital transfer with the drip and ship model?
within 60 min
What does the presence of a perfusion/diffusion study mismatch indicate?
salvageable brain tissue
What unique equipment is required to be onboard a mobile stroke unit?
CT scanner
What diagnostic test would be helpful when considering differential diagnoses for patients with signs and symptoms that mimic stroke?
toxicology screen
What diagnostic tests must be completed before thrombolytic administration?
Blood glucose and brain CT/MRI
What condition would include a patient for consideration to receive alteplase?
mild, disabling stroke