Stroke Flashcard 4

B. Rationale: Fibrinolytic therapy should be provided to eligible patients within 3 hours of symptom onset and 1 hour of ED arrival.

B. Rationale: The most important question is, “When was the last time you saw the patient acting normally?” The answer to this question establishes time zero and will determine whether the patient is a candidate for fibrinolytic therapy if he has had an ischemic stroke.

C. Rationale: All of these are possible signs of stroke. Other signs may include dizziness or loss of balance/coordination, vision difficulties in one or both eyes, and sudden weakness/numbness of the face, arm, or leg (especially on one side of the body).

D. Rationale: The 8 D’s of stroke care remind us of the major steps in diagnosing and treating stroke, and they identify the key points at which delays in treatment can occur. The 8 D’s are detection (recognition of stroke); dispatch (early dispatch of EMS); delivery (EMS identification, treatment, and transport to hospital); door (appropriate triage to a stroke center); data (triage, evaluation, and management in the ED); decision (therapy selection); drug (fibrinolytic therapy or intra-arterial strategies); and disposition (admission to stroke unit or CCU). All of these steps should be performed as rapidly as possible.

B. Rationale: The 8 Ds of stroke care is a must-know topic in the diagnosis and management of stroke patients.

B. Rationale: Detection pertains to the recognition of the stroke symptoms. Data is the rapid triage, evaluation, and management in the emergency department. Delivery is the EMS identification of stroke symptoms and transport of the patient to a suitable stroke facility. Disposition is the admission of the patient to an acute stroke unit or intensive care unit.

C. Rationale: Superior outcomes can be difficult to replicate in hospitals with less experience in and institutional commitment to acute stroke care.

D. Rationale: The Cincinnati Stroke Scale identifies stroke using three physical findings: facial droop, arm drift, and abnormal speech. The presence of 1 finding has a sensitivity of 59% and a specificity of 89% when scored by prehospital providers.

C. Rationale: The Cincinnati Prehospital Stroke Scale includes three criteria and should be performed by all EMS personnel, who should be trained to recognize stroke in accordance with the AHA guidelines.

C. Rationale: The first critical decision point in the ACLS suspected stroke algorithm is the performance and assessment of a non-contrast CT to determine the type of stroke experienced. General assessment and stabilization are performed for all patients. Consideration for fibrinolytic therapy and discussion of risks and benefits occur later for patients identified as having had an ischemic stroke.