HEMISPHERE IV-RAPID STROKE RESPONSE EXAM QUESTION
AND ANSWERS
1. EMS goal on scene ANSWER - 15 minutes
2. Oxygen saturation in stroke ANSWER - >94%
3. Onset of symptoms to thrombolytics time ANSWER - 4.5 hours
4. Onset of symptoms to thrombectomy time ANSWER - 24 hours
5. Stroke Center designations ANSWER - Comprehensive Stroke
Center (CSC) Thrombectomy-capable stroke center (TSC)
Primary Stroke Center (PSC)
Acute Stroke Ready Hospital (ASRH)
6. Door to door transfer time ANSWER - <= 60 min hospital to hospital transfer
7. associated symptoms of stroke ANSWER - *especially with cerebellar and hemorrhagic
stroke vomiting, nausea
SBP >220
stitt neck
Photophobia
Coma and decreased level of consciousness
8. Overlooked symptoms of stroke ANSWER -
dizziness headache
general weakness or fatigue
nausea, vomiting
disorientation, confusion, or memory problems
9. Door to doctor time ANSWER - ASAP - 10 min
10. BP parameters ANSWER - do not treat elevated BP unless concurrent myocardial infarction, heart failure,
aortic dissection, or confirmed hemorrhagic stroke
11. Door to stroke team time (neuro expertise) ANSWER - ASAP - 15
12. Prior to thrombolytic ANSWER - Noncontract CT or MRI to exclude
hemorrhage Blood glucose level - to rule out hypoglycemia
BP under 180/105
13. When to repeat CT in Hosp to hosp transfers ANSWER - >60 minutes since last CT
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, 14. Baseline labs ANSWER - CBC, electrolytes, Renal function creatinine, troponin and ecg to evaluate MI and
arrhythmias Coag studies if on anticoagulants
Advanced imaging if considering mechanical thrombectomy
15. Airway management ANSWER - Swallow screen should be performed on all stroke
patients npo until complete
16. How long is BP elevated after stroke ANSWER - 24-48 hrs
17. Increased cardiac risk with stroke ANSWER - Arrhythmias (including A-fib) observed in about 25% of
patients within 72 hrs of stroke
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
18. Blood glucose and stroke ANSWER - Persistent hyperglycemia 24 hours following stroke is associated with
worse outcomes
Hypoglycemia can mimic stroke symptoms
Maintain glucose >60 and <180
19. When to raise bed 30 degrees ANSWER
- Risk for Aspiration
Cardiopulmonary issues
Increased intracranial pressure
20. Temperature and strokes ANSWER - Fever increases metabolic demand, which may increase risk of brain
injury
21. Stroke mimics ANSWER -
Hypoglycemia TIA
Seizure
Migraine
Toxic Metabolic Cause
Sepsis
Syncope
Mass Lesion
Conversion Disorder
22. AEIOU tips ANSWER - Causes of
mental status A alcohol acidosis
E epilepsy, encephalopathy I
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AND ANSWERS
1. EMS goal on scene ANSWER - 15 minutes
2. Oxygen saturation in stroke ANSWER - >94%
3. Onset of symptoms to thrombolytics time ANSWER - 4.5 hours
4. Onset of symptoms to thrombectomy time ANSWER - 24 hours
5. Stroke Center designations ANSWER - Comprehensive Stroke
Center (CSC) Thrombectomy-capable stroke center (TSC)
Primary Stroke Center (PSC)
Acute Stroke Ready Hospital (ASRH)
6. Door to door transfer time ANSWER - <= 60 min hospital to hospital transfer
7. associated symptoms of stroke ANSWER - *especially with cerebellar and hemorrhagic
stroke vomiting, nausea
SBP >220
stitt neck
Photophobia
Coma and decreased level of consciousness
8. Overlooked symptoms of stroke ANSWER -
dizziness headache
general weakness or fatigue
nausea, vomiting
disorientation, confusion, or memory problems
9. Door to doctor time ANSWER - ASAP - 10 min
10. BP parameters ANSWER - do not treat elevated BP unless concurrent myocardial infarction, heart failure,
aortic dissection, or confirmed hemorrhagic stroke
11. Door to stroke team time (neuro expertise) ANSWER - ASAP - 15
12. Prior to thrombolytic ANSWER - Noncontract CT or MRI to exclude
hemorrhage Blood glucose level - to rule out hypoglycemia
BP under 180/105
13. When to repeat CT in Hosp to hosp transfers ANSWER - >60 minutes since last CT
1|Page
, 14. Baseline labs ANSWER - CBC, electrolytes, Renal function creatinine, troponin and ecg to evaluate MI and
arrhythmias Coag studies if on anticoagulants
Advanced imaging if considering mechanical thrombectomy
15. Airway management ANSWER - Swallow screen should be performed on all stroke
patients npo until complete
16. How long is BP elevated after stroke ANSWER - 24-48 hrs
17. Increased cardiac risk with stroke ANSWER - Arrhythmias (including A-fib) observed in about 25% of
patients within 72 hrs of stroke
Cardiac troponin may elevate from autonomic dysfunction in acute MI/heart failure
18. Blood glucose and stroke ANSWER - Persistent hyperglycemia 24 hours following stroke is associated with
worse outcomes
Hypoglycemia can mimic stroke symptoms
Maintain glucose >60 and <180
19. When to raise bed 30 degrees ANSWER
- Risk for Aspiration
Cardiopulmonary issues
Increased intracranial pressure
20. Temperature and strokes ANSWER - Fever increases metabolic demand, which may increase risk of brain
injury
21. Stroke mimics ANSWER -
Hypoglycemia TIA
Seizure
Migraine
Toxic Metabolic Cause
Sepsis
Syncope
Mass Lesion
Conversion Disorder
22. AEIOU tips ANSWER - Causes of
mental status A alcohol acidosis
E epilepsy, encephalopathy I
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