SCRN study guide: hyperacute care exam/41
Questions and Solved Answers.
Communicate effectively with pre-hospital personnel. - -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 - -Obtain last seen normal
Obtain blood glucose
-ABCD score - -A: age B: blood C: clinical features D: Duration of TIA symptoms
-Establish ABC's - -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 - -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 - -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
Questions and Solved Answers.
Communicate effectively with pre-hospital personnel. - -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 - -Obtain last seen normal
Obtain blood glucose
-ABCD score - -A: age B: blood C: clinical features D: Duration of TIA symptoms
-Establish ABC's - -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 - -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 - -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
