Stroke/TIA

Question 1

When is symptom onset time taken?

Answer 1

Taken from time pt was last seen well.

Question 2

How long is a patient eligible for thrombolysis from symptom onset time?

Answer 2

4.5 hours

Question 3

What percentage of strokes are ICH?

Answer 3

15%.

Question 4

When can TIA be suspected, and do they require hospital transport?

Answer 4

If signs and symptoms completely resolve.

These pts require transport as TIA is often a sign of impending stroke.

Question 5

What are 6 indicators of ICH?

Answer 5

1. GCS <10 and the pt is not alert
2. Pt c/o severe headache
3. N+V present
4. Slow pulse and hypertension noted
5. Pupil abnormalities
6. Abnormal respiratory patterns noted.

Question 6

What note is made about intubation in stroke patients?

Answer 6

May be considered for difficult airways, but not routine practice - consider time to hospital vs. procedure time.

Question 7

Why considerations need to be made regarding the administration of Prochlorperazine in stroke pts?

Answer 7

Can cause drowsiness, its use needs to be balanced against a potential reduction in conscious state of these patients.

Question 8

What are the 3 ASSESS points under the Stroke guideline?

Answer 8

1. Symptom onset time
2. Stroke mimics
3. Co-morbidities

Question 9

What are the 10 listed stroke mimics?

Answer 9

1. Intoxication drug/alcohol
2. Hypo/hyperglycaemia
3. Seizures
4. Brain tumour
5. Syncope
6. Middle ear disorder
7. Migraine
8. Subdural haematoma
9. Sepsis
10. Electrolyte disturbances

Question 10

What are the 2 listed stroke co-morbidities?

Answer 10

1. Dementia

2. Significant pre-existing disability

Question 11

What is the MASS criteria?

Answer 11

In the setting of normal BGL, a finding of one or more of:

1. Facial droop
2. Abnormal speech
3. Abnormal grip

Question 12

How is Facial Droop assessed, and what is an abnormal finding that is indicative of stroke?

Answer 12

Ask pt to show teeth or smile.

Abnormal - one side of face does not move as well as the other

Question 13

How is Speech assessed, and what is an abnormal finding that is indicative of stroke?

Answer 13

The pt states “You can’t teach an old dog new tricks.”

Abnormal finding: slurs, says wrong words or is unable to speak/understand

Question 14

How is Hand Grip assessed, and what is an abnormal finding that is indicative of stroke?

Answer 14

Test as for GCS.

Abnormal finding: unilateral weakness

Question 15

If stroke identified, what is the management?

Answer 15

1. BLS for airway/ventilation
2. Support affected limbs
3. Mx symptoms (seizures, nausea)
4. Obtain 18g IV access with a bung in cub. foss.
5. Analgesia as per headache

Question 16

Which patients should be transported to nearest thrombolysis hospital/stroke unit care with notification?

Answer 16

Stable pt with no significant co-morbidities, onset time of <4.5hrs and Tx time of <1hr.

Question 17

Which patients should be transported to the nearest centre, preferably with stroke unit care/CT imaging?

Answer 17

If unstable, or has significant comorbidity, or onset/Tx time outside parameters.

Question 18

What is the benefit of MICA for the stroke pt?

Answer 18

If GCS <10, ETT.