Stroke Flashcard 6

B. Rationale: The National Institute of Health Stroke Scale (NIHSS) is a detailed neurological examination tool that helps in the assessment of stroke. Unlike the Cincinnati Prehospital Stroke Scale, the NIHSS has a detailed 15-item test that evaluates the neurological function of a responsive suspected stroke patient. The AHA recommends the use of the NIHSS tool.

C. Rationale: According to the NINDS, the stroke team has up to 45 minutes to obtain a CT scan and interpret the results (ischemic vs. hemorrhagic stroke).

C. Rationale: Endovascular therapy must be given within 6 hours of the onset of symptoms to achieve good neurologic outcomes. These patients must be transferred to treatment facilities adept at managing acute stroke patients. (Case: Suspected Stroke)

D. Rationale: Once a CT scan confirms the presence of a hemorrhagic stroke, the team initiates the intracranial hemorrhage protocol. Neurosurgery is called to consult, and the patient is transferred to the neurologic ICU. This is covered by the hemorrhagic stroke pathway on the algorithm, which is no longer the scope of this course.

B. Rationale: To provide the proper therapeutic interventions for a patient with acute stroke, it is important to know if pharmacologic therapy will be effective. Intravenous fibrinolytic therapy is only used if it can be given within 3–4.5 hours after the onset of symptoms. Endovascular therapy can be pursued if the onset of symptoms is within 6 hours.

D. Rationale: Chest pain is not a sign of stroke. 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. Following the Cincinnati Prehospital Stroke Scale (CPSS), when all three of these clinical signs are present, there is > 85% chance the patient has had a stroke. If one sign is present, there is a 72% chance that the patient has had a stroke. (Case: Suspected Stroke)

D. Rationale: The most commonly used and effective fibrinolytic for the treatment of acute ischemic stroke within 3 to 4.5 hours is the rTPA or recombinant-tissue plasmin activator.

D. Rationale: Ischemic stroke is the most common cause of stroke in adults, comprising about 87% of stroke patients. Ischemic stroke requires medical treatment, while hemorrhagic stroke requires surgical interventions. (Case: Suspected Stroke)

D. Rationale: Multi lobar infarction on CT scan is one of the exclusion criteria for fibrinolytic therapy. Significant head trauma would be an exclusion factor if the trauma were within the preceding 3 months. Blood glucose < 50 mg/dL is an exclusion factor. (ACLS Case: Acute Stroke: Inclusion and Exclusion Criteria)

D. Rationale: Head trauma or prior stroke within 3 months is one of the exclusion criteria for fibrinolytic therapy. Elevated systolic blood pressure > 185 mm Hg or diastolic blood pressure > 110 mm Hg also excludes the patient, as does the current use of anticoagulants if INR is > 1.7 or PT is > 15 seconds. Having had a seizure at the stroke onset is a relative, not an absolute, contraindication.