Stroke Flashcard 2

A. Rationale: The stroke chain of survival provides healthcare providers a framework for focused training to increase the chances of successful treatment of a stroke patient. Prompt recognition of stroke signs and calling EMS make up the first link in the stroke chain of survival, timely EMS response is the second link, transport to and notifying a stroke unit is the third link, and the fourth link is the diagnosis and treatment of the patient in the hospital, preferably an institution with a dedicated stroke unit.

A. Rationale: The stroke chain of survival provides healthcare providers a framework for training to improve the chance of successful treatment. Recognition of stroke signs and calling EMS make up the first link in the stroke chain of survival. Timely EMS response is the second link, transport to and notification of a stroke unit is the third link, and the fourth link is the diagnosis and treatment of the patient in the hospital, preferably in an institution with a stroke unit.

B. Rationale: The early recognition of stroke signs and symptoms is essential for good neurologic outcome in patients. Signs include facial droop, arm drift, and abnormal speech. Using the Cincinnati Prehospital Stroke Scale there is more than an 85% chance that the patient has had a stroke when all three of these clinical signs are present. If one sign is present, there is a 72% chance the patient has had a stroke.

D. Rationale: Multilobar infarction on CT scan is part of the exclusion criteria for fibrinolytic therapy. Significant head trauma would be an exclusion factor if the trauma was within the last 3 months. Blood glucose < 50 mg/dL is an exclusion factor.

B. Rationale: Facial droop, especially on one side, is a common sign of stroke. Other signs include weakness on one side of the body, an abrupt loss of vision, and difficulty speaking or understanding others. While a carotid bruit may be heard in a patient with carotid stenosis and may be associated with stroke risk, this is not a sign of acute stroke. Typically, signs of stroke occur suddenly but are maintained for several hours. It is less common for a patient to have a sudden loss of consciousness from a stroke. Likewise, stroke does not typically lead to acute respiratory distress. However, it is wise to monitor oxygen saturation and maintain it above 94%.

D. Rationale: Ischemic stroke is the most common cause of stroke in adults, comprising about 87% of stroke patients. Ischemic stroke is treated medically while hemorrhagic stroke is treated surgically.

D. Rationale: The recombinant tissue plasmin activator is the fibrinolytic of choice for patients with acute ischemic stroke. It is administered only by an experienced physician and must be given within 3 hours or 4.5 hours in selected patients. Better outcomes are observed if treatment is given early.

B. Rationale: The NIH stroke scale is a validated tool used to evaluate stroke severity. It is useful as it provides a standardized measurement of baseline function and is correlated with patient outcome. It evaluates consciousness, vision and eye movements, sensation, language, and motor and cerebellar functioning but not memory. While a low score under 4–5 typically suggests minor abnormalities, a patient can have disabling deficits in one area and may benefit from fibrinolysis. While language barriers or intubation can make the test more difficult, it can still be used in these situations. Intubated patients can be asked to write down answers or follow simple nonverbal commands. If a language barrier exists, pantomiming can be used.