Acute Care

Question 1

Fisher Scale

Answer 1

SAH-predictor of vasospasm
grade 1-4 (4 includes any IVH)

Question 2

GCS

Answer 2

Coma scale 3-15

Question 3

NIHSS

Answer 3

0-42

Question 4

ICH score

Answer 4

1-6, predictor of 30 day mortality and functional outcome

Question 5

Hunt and Hess

Answer 5

0-5, severity of SAH, predictor of mortality, vasospasm and functional outcome

Question 6

How long is acute care?

Answer 6

24 hr post insult-discharge

Question 7

Janeway Lesions

Answer 7

NON painful hemorrhagic papules

Question 8

Osler’s Nodes

Answer 8

TENDER/pailful nodules, infective endocarditis

Question 9

Target glucose

Answer 9

140-180

Question 10

How much glucose does the brain consume?

Answer 10

20-25%

Question 11

What is hyperglycemia associated with in ICH?

Answer 11

Increased mortality

Question 12

What is the glucose goal for SAH?

Answer 12

> 105

Question 13

Define central fever

Answer 13

Spontaneous increase in temp in brain injured patients, not related to infection

Question 13

What percentage of brain injured patients experience fever?

Answer 13

70%

Question 14

What is goal temp?

Answer 14

37

Question 15

What meds are used to manage shivering?

Answer 15

Mag
Buspirone
Dantrolene
Meperidine

Question 16

Last resort for managing shivering?

Answer 16

Sedation and paralyze

Question 17

What are the scores for bedside shivering assessment? How often?

Answer 17

q1, 0-3

Question 18

What care plans are needed post stroke?

Answer 18

Fall
Aspiration
Seizure
Skin
Infection, including UTI
Elimination
Nutrition: hydration!!
VTE
Stress ulcer
Early mobilization
Education
Spiritual

Question 19

Define orthostatic hypotension

Answer 19

If SBP drops >=20, or DBP drops >=10

Question 20

What percentage of patients develop angioedema post TPA?

Answer 20

2%

Question 21

What percentage of patients develop hemorrhagic transformation?

Answer 21

6.8%

Question 22

What can increase risk of hemorrhagic transformation post tnk?

Answer 22

Large infarct area

Question 23

When can you start medical VTE prophylaxis for ischemic strokes?

Answer 23

24-48 hrs

Question 24

When should you start mobilizing hemodynamically stable patients?

Answer 24

24-48 hrs

Question 25

When is seizure risk highest in ICH?

Answer 25

First 24 hrs

Question 26

Complications of femoral artery access

Answer 26

Hematoma Arterial dissection Retroperitoneal hemorrhage

Question 27

CEA

Answer 27

Carotid enterectomy, clean the artery out

Question 28

CAS

Answer 28

Carotid artery stent

Question 29

What is treatment for PFO?

Answer 29

Anticoags until patch

Question 30

When can you start medical VTE prophylaxis post SAH?

Answer 30

1-4 d, maybe. But use SCDS

Question 31

What are the signs of ruptured aneurysm?

Answer 31

Worst HA Nuchal rigidity N/V Photophobia Positive kernig and/or brudzinkski Altered LOC

Question 32

Kernig

Answer 32

Hamstring pain when moving knee from bent to straight

Question 33

Brudzinski

Answer 33

While supine, lift neck and has involuntary hip flexion

Question 34

How can you treat aneurysm?

Answer 34

Coil, stent, clip

Question 35

When is rebleeding likely to occur post aneurysm coil?

Answer 35

3-11 days most likely r/t htn

Question 36

What is another complication of aSAH?

Answer 36

Vasospasm

Question 37

When can vasospasm occur?

Answer 37

4-14 days

Question 38

What are signs of vasospasm?

Answer 38

Decreased LOC Gradual neuro deterioration Cranial nerve deficits Aphasia

Question 39

ABCD2

Answer 39

Scale determining likelihood of stroke post TIA, 0-5

Question 40

Watershed stroke

Answer 40

Connected vessels

Question 41

Lacunar stroke

Answer 41

Small vessel

Question 42

When can you start anticoags for afib post large infarct?

Answer 42

10-14 days