HEMISPHERE IV-RAPID STROKE
RESPONSE QUESTIONS & ANSWERS
EMS goal on scene - ANSWER15 minutes
Oxygen saturation in stroke - ANSWER>94%
Onset of symptoms to thrombolytics time - ANSWER4.5 hours
Onset of symptoms to thrombectomy time - ANSWER24 hours
Stroke Center designations - ANSWERComprehensive Stroke Center (CSC)
Thrombectomy-capable stroke center (TSC)
Primary Stroke Center (PSC)
Acute Stroke Ready Hospital (ASRH)
Door to door transfer time - ANSWER<= 60 min hospital to hospital transfer
associated symptoms of stroke - ANSWER*especially with cerebellar and hemorrhagic
stroke
vomiting, nausea
SBP >220
stiff neck
Photophobia
Coma and decreased level of consciousness
Overlooked symptoms of stroke - ANSWERdizziness
headache
general weakness or fatigue
nausea, vomiting
disorientation, confusion, or memory problems
Door to doctor time - ANSWERASAP - 10 min
BP parameters - ANSWERdo not treat elevated BP unless concurrent myocardial
infarction, heart failure, aortic dissection, or confirmed hemorrhagic stroke
Door to stroke team time (neuro expertise) - ANSWERASAP - 15
Prior to thrombolytic - ANSWERNoncontract CT or MRI to exclude hemorrhage
Blood glucose level - to rule out hypoglycemia
BP under 180/105
When to repeat CT in Hosp to hosp transfers - ANSWER>60 minutes since last CT
, Baseline labs - ANSWERCBC, electrolytes, Renal function creatinine, troponin and ecg
to evaluate MI and arrhythmias
Coag studies if on anticoagulants
Advanced imaging if considering mechanical thrombectomy
Airway management - ANSWERSwallow screen should be performed on all stroke
patients
npo until complete
How long is BP elevated after stroke - ANSWER24-48 hrs
Increased cardiac risk with stroke - ANSWERArrhythmias (including A-fib) observed in
about 25% of patients within 72 hrs of stroke
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
Blood glucose and stroke - ANSWERPersistent hyperglycemia 24 hours following
stroke is associated with worse outcomes
Hypoglycemia can mimic stroke symptoms
Maintain glucose >60 and <180
When to raise bed 30 degrees - ANSWERRisk for
Aspiration
Cardiopulmonary issues
Increased intracranial pressure
Ischemic tissue on cT - ANSWERless dense or hypodense, so appears darker than
normal
Acute hemorrhage on CT - ANSWERbright white
CT interpretation - Blood Can Be Very Bad - ANSWERBlood - no
hematoma/hemorrhage
Cisterns-no blood in spaces/symmetrical
brain tissue - no tissue hypo/hyper densities and no masses,
Ventricles - symmetrical and midline
Bone - no skull fracture
ASPECTS score - ANSWERAlberta Stroke Program
used to quantify the extent of ischemic changes in the MCA territory on NCCT and
determine eligibility for mechanical thrombectomy
ASPECTS explained - ANSWER10 point scoring tool with one point for each region of
MCA circulation. One point is subtracted for each region with ischemia/hypodensity
RESPONSE QUESTIONS & ANSWERS
EMS goal on scene - ANSWER15 minutes
Oxygen saturation in stroke - ANSWER>94%
Onset of symptoms to thrombolytics time - ANSWER4.5 hours
Onset of symptoms to thrombectomy time - ANSWER24 hours
Stroke Center designations - ANSWERComprehensive Stroke Center (CSC)
Thrombectomy-capable stroke center (TSC)
Primary Stroke Center (PSC)
Acute Stroke Ready Hospital (ASRH)
Door to door transfer time - ANSWER<= 60 min hospital to hospital transfer
associated symptoms of stroke - ANSWER*especially with cerebellar and hemorrhagic
stroke
vomiting, nausea
SBP >220
stiff neck
Photophobia
Coma and decreased level of consciousness
Overlooked symptoms of stroke - ANSWERdizziness
headache
general weakness or fatigue
nausea, vomiting
disorientation, confusion, or memory problems
Door to doctor time - ANSWERASAP - 10 min
BP parameters - ANSWERdo not treat elevated BP unless concurrent myocardial
infarction, heart failure, aortic dissection, or confirmed hemorrhagic stroke
Door to stroke team time (neuro expertise) - ANSWERASAP - 15
Prior to thrombolytic - ANSWERNoncontract CT or MRI to exclude hemorrhage
Blood glucose level - to rule out hypoglycemia
BP under 180/105
When to repeat CT in Hosp to hosp transfers - ANSWER>60 minutes since last CT
, Baseline labs - ANSWERCBC, electrolytes, Renal function creatinine, troponin and ecg
to evaluate MI and arrhythmias
Coag studies if on anticoagulants
Advanced imaging if considering mechanical thrombectomy
Airway management - ANSWERSwallow screen should be performed on all stroke
patients
npo until complete
How long is BP elevated after stroke - ANSWER24-48 hrs
Increased cardiac risk with stroke - ANSWERArrhythmias (including A-fib) observed in
about 25% of patients within 72 hrs of stroke
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
Blood glucose and stroke - ANSWERPersistent hyperglycemia 24 hours following
stroke is associated with worse outcomes
Hypoglycemia can mimic stroke symptoms
Maintain glucose >60 and <180
When to raise bed 30 degrees - ANSWERRisk for
Aspiration
Cardiopulmonary issues
Increased intracranial pressure
Ischemic tissue on cT - ANSWERless dense or hypodense, so appears darker than
normal
Acute hemorrhage on CT - ANSWERbright white
CT interpretation - Blood Can Be Very Bad - ANSWERBlood - no
hematoma/hemorrhage
Cisterns-no blood in spaces/symmetrical
brain tissue - no tissue hypo/hyper densities and no masses,
Ventricles - symmetrical and midline
Bone - no skull fracture
ASPECTS score - ANSWERAlberta Stroke Program
used to quantify the extent of ischemic changes in the MCA territory on NCCT and
determine eligibility for mechanical thrombectomy
ASPECTS explained - ANSWER10 point scoring tool with one point for each region of
MCA circulation. One point is subtracted for each region with ischemia/hypodensity
