SCRN study guide: hyper acute care Exam 2023

Communicate effectively with pre-hospital personnel. - Answer- When stroke victim activates EMS the time to imaging , neuro exam, ED MD evaluation is shorter. This should be emphasized in the community. The greatest time delay is from symptom onset to ED arrival. EMS alerts the hospital, advance notification by EMS has shown to increase the use of TpA EMS evaluation primary goals - Answer- Obtain last seen normal Obtain blood glucose ABCD score - Answer- A: age B: blood C: clinical features D: Duration of TIA symptoms Establish ABC's - Answer- Airway -Breathing: O2 for SpO2< 94% Circulation: ECG, BP assessment & IV/Labs (√BG) D (Neuro): NIHSS or Canadian Neurological Scale (CNS), Neuro Exam & Neuro MD Posterior stroke - Answer- There are important differences between posterior and anterior circulation stroke. The differences include the value of screening instruments, optimum diagnostic modalities, and clinical features. The face arm speech test (FAST), a widely used prehospital stroke recognition screening instrument, is less sensitive for detecting posterior circulation stroke than for anterior circulation stroke Symptoms of Posterior Circulation Stroke - Answer- Motor deficits (weakness, clumsiness, or paralysis of any combination of arms and legs, up to quadriplegia, sometimes changing from one side to another in different attacks) "Crossed" syndromes, consisting of ipsilateral cranial nerve dysfunction and contralateral long motor or sensory tract dysfunction are highly characteristic of posterior circulation stroke Sensory deficits (numbness, including loss of sensation or paraesthesia in any combination of extremities, sometimes including all four limbs or both sides of the face or mouth) Homonymous hemianopia—a visual field defect affecting either the two right or the two left halves of the visual fields of both eyes Ataxia, imbalance, unsteadiness, or disequilibrium Vertigo, with or without nausea and vomiting Diplopia as a result of ophthalmoplegia Dysphagia or dysarthria Isolated reduced level of consciousness is not a typical stroke symptom but can result from bilateral thalamic or brainstem ischaemia (especially from rostral basilar artery occlusion) Posterior stroke: Lateral medulla (intracranial vertebral artery infarct, also known as Wallenberg syndrome) - Answer- Nystagmus, vertigo, ipsilateral Horner's syndrome, ipsilateral facial sensory loss, dysarthria, hoarseness, and dysphagia Contralateral hemisensory loss in the trunk and limb—pain and temperature posterior stroke: Medial medulla - Answer- Ipsilateral tongue weakness and later hemiatrophy of the tongue Contralateral hemiparesis of the arm and leg Hemisensory loss—touch and proprioception posterior stroke: Pons - Answer- Hemiparesis or hemisensory loss, ataxic hemiparesis, dysarthria, horizontal gaze palsy Complete infarction causes "locked-in syndrome" with quadriparesis, loss of speech, but preserved awareness and cognition, and sometimes preserved eye movements posterior stroke:Top of the basilar (distal basilar occlusion) - Answer- Somnolence, confusion (from thalamic infarction) Bilateral loss of vision, unawareness or denial of blindness (from bilateral occipital infarction) posterior stroke: Posterior inferior cerebellar artery - Answer- Truncal ataxia, vertigo (limb ataxia may occur, especially if the inferior cerebellar peduncle is affected) posterior stroke: Posterior cerebral artery - Answer- Contralateral homonymous hemianopia (from occipital infarction) Hemisensory loss—all modalities (from thalamic infarction) Hemi-body pain—pain (usually with a burning quality) down one side of the body (face, arm, and leg) as a result of thalamic infarction If bilateral, may have poor visual-motor coordination, inability to understand visual objects Symptoms of Anterior Circulation Stroke - Answer- Patients typically present with sudden onset of focal neurological symptoms. Anterior Circulation Stroke: Left hemisphere (ie, dominant) - Answer- • Right hemiparesis - Variable involvement of face and upper and lower extremity • Right-sided sensory loss in a pattern similar to that of the motor deficit - Usually involves all modalities, decreased stereognosis, and graphesthesia • Right homonymous hemianopia