NU 431 Exam 2 Guide With
Complete Solution
Are Ischemic strokes or hemorrhagic strokes more common? - ANSWER
Ischemic- 87%
Hemorrhagic- 13%
A stroke is an acute neurologic impairment, caused by disruption in blood
flow to the brain.
Signs of a stroke - ANSWER - Sudden weakness or numbness in the face, arm
or leg, especially one side of the body
- Sudden confusion
- Trouble speaking (expressive) or understanding (receptive)
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking
- Dizziness or loww of balance or coordination
- Sudden severe HA with no known cause
Stroke Risk Factors- Ischemic v. Hemorrhagic - ANSWER Ischemic
- HTN
- Cigarette smoking
- Hypercholesterolemia
,- Illicit drug use
- Age >55
Hemorrhagic
- HTN
- Cigarette smoking
- Heavy ETOH use
- Sympathetic nervous system stimulants
Stroke Chain of Survival
The eight D's of Stroke Care - ANSWER Early Symptom Recognition & Call for
Help--> EMS Eval & Tx--> Emergency Dept Evaluation and Tx--> Reperfusion
Therapy
Detection- rapid recognition of stroke sxs.
Dispatch- Early activation and dispatch of EMS by 911.
Delivery- Rapid EMS identification, mgmt, transport.
Door- Appropriate triage to stroke center.
Data- Rapid triage, eval, mgmt in ED.
Decision- stroke expertise and therapy selection.
Drug- fibrinolytic therapy, intra-arterial strategies.
Disposition: rapid admission to stroke unit or ICU
The Cincinnati Prehospital Stroke Scale aka Stroke Assessment - ANSWER
Facial droop- have pt show teeth of smile
,N: both sides face move equally
Arm drift- have pt close eyes and extend both arms straight out with palms
up for 10 sec
N: both arms move the same or both arms do not move
Abnormal speech-
have pt say "you can't teach an old dog new tricks."
N: no slur, can speak
= If any of these 3 sx is abnormal, the probability of a stroke is 72%
FYI:
ACT FAST- KNOW THE LAST PT TIME PT WAS SEEN NORMAL
BEFAST
- Balance-
- Eyes- lost vision?
-Fast- uneven?
-Arms- weak or numb?
- Speech- slurred? confusion? trouble speaking?
- Time- CALL 911
Suspected Stroke Algorithm:
Immediate general assessment and stabilization-->
Immediate neurologic assessment by stroke team-->
, Does CT scan show hemorrhage? - ANSWER Immediate general
assessment:(within 10 mins)
- Assess vital signs
- Provide O2 as indicated
- Obtain IV access
- Check glucose PRN
- Obtain 12-lead ECG
- Perform neurologic screen
- Order emergent CT brain or MRI scan
Immediate neurologic assessment by stroke team: (within 20 mins)
- Review pt hx
- Establish time of symptom onset or last know normal
- Perform neurologic exam (NIH Stroke Scale)
Does CT Scan Show Hemorrhage?-- STAT CT
No-- check fibrinolytic exclusions. Repeat neuro exam. Review the
risks/benefits with pt &family if acceptable give rTPA. No anticoagulants or
antiplatelets tx for 24 hrs.
Yes-- consult neurologist or neurosurgeon. Consider transfer if not available.
Admit to stroke unit or ICU. -- Consider EVT (endovascular thrombectomy)
transfer within 60 mins.
Within 10 mins of ED arrival what should you do?
Complete Solution
Are Ischemic strokes or hemorrhagic strokes more common? - ANSWER
Ischemic- 87%
Hemorrhagic- 13%
A stroke is an acute neurologic impairment, caused by disruption in blood
flow to the brain.
Signs of a stroke - ANSWER - Sudden weakness or numbness in the face, arm
or leg, especially one side of the body
- Sudden confusion
- Trouble speaking (expressive) or understanding (receptive)
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking
- Dizziness or loww of balance or coordination
- Sudden severe HA with no known cause
Stroke Risk Factors- Ischemic v. Hemorrhagic - ANSWER Ischemic
- HTN
- Cigarette smoking
- Hypercholesterolemia
,- Illicit drug use
- Age >55
Hemorrhagic
- HTN
- Cigarette smoking
- Heavy ETOH use
- Sympathetic nervous system stimulants
Stroke Chain of Survival
The eight D's of Stroke Care - ANSWER Early Symptom Recognition & Call for
Help--> EMS Eval & Tx--> Emergency Dept Evaluation and Tx--> Reperfusion
Therapy
Detection- rapid recognition of stroke sxs.
Dispatch- Early activation and dispatch of EMS by 911.
Delivery- Rapid EMS identification, mgmt, transport.
Door- Appropriate triage to stroke center.
Data- Rapid triage, eval, mgmt in ED.
Decision- stroke expertise and therapy selection.
Drug- fibrinolytic therapy, intra-arterial strategies.
Disposition: rapid admission to stroke unit or ICU
The Cincinnati Prehospital Stroke Scale aka Stroke Assessment - ANSWER
Facial droop- have pt show teeth of smile
,N: both sides face move equally
Arm drift- have pt close eyes and extend both arms straight out with palms
up for 10 sec
N: both arms move the same or both arms do not move
Abnormal speech-
have pt say "you can't teach an old dog new tricks."
N: no slur, can speak
= If any of these 3 sx is abnormal, the probability of a stroke is 72%
FYI:
ACT FAST- KNOW THE LAST PT TIME PT WAS SEEN NORMAL
BEFAST
- Balance-
- Eyes- lost vision?
-Fast- uneven?
-Arms- weak or numb?
- Speech- slurred? confusion? trouble speaking?
- Time- CALL 911
Suspected Stroke Algorithm:
Immediate general assessment and stabilization-->
Immediate neurologic assessment by stroke team-->
, Does CT scan show hemorrhage? - ANSWER Immediate general
assessment:(within 10 mins)
- Assess vital signs
- Provide O2 as indicated
- Obtain IV access
- Check glucose PRN
- Obtain 12-lead ECG
- Perform neurologic screen
- Order emergent CT brain or MRI scan
Immediate neurologic assessment by stroke team: (within 20 mins)
- Review pt hx
- Establish time of symptom onset or last know normal
- Perform neurologic exam (NIH Stroke Scale)
Does CT Scan Show Hemorrhage?-- STAT CT
No-- check fibrinolytic exclusions. Repeat neuro exam. Review the
risks/benefits with pt &family if acceptable give rTPA. No anticoagulants or
antiplatelets tx for 24 hrs.
Yes-- consult neurologist or neurosurgeon. Consider transfer if not available.
Admit to stroke unit or ICU. -- Consider EVT (endovascular thrombectomy)
transfer within 60 mins.
Within 10 mins of ED arrival what should you do?
