CPG - A0711 - Stroke

Question 1

what are the stroke mimics?

Answer 1

• Hypo/hyperglycaemia
• Seizures
• Sepsis
• Intoxication
• Brain tumour
• Inner ear disorder
• Subdural haemotoma
• Syncope
• Migrane
• Electrolyte imbalence

Question 2

What are the significant cvo-morbidities of stroke?

Answer 2

• Dementia

- Significant pre-exisiting physical disability

Question 3

what % of strokes are intracaranial hamorrhage?

Answer 3

15-20%

Question 4

what are the signs that indicate that Intracranial haemorrhage is more likely than Ischaemic stroke?

Answer 4

• Rapid deterioration of conscious state and GCS <8
• complaint of severe headache
• nausea/vomitting
• bradycardia/hypertension

Question 5

what is the thrombolysis eligibility timeframe?

Answer 5

up to 12 hours from onset of symptoms

Question 6

How do you manage orolingual angiodema resulting from post thrombolysis?

Answer 6

adrenaline 5mg in 5ml Nebulised

Question 7

What is the Endovascular clot retrieval timeframe?

Answer 7

up to 24 hours from symptom onset

Question 8

what do you do if

MASS positive >12 hours

AND

ACT FAST negative or suspected TIA

Answer 8

NON URGENT TRANSPORT

Transport to nearest thrombolysising stroke centre

Question 9

What do you do if

MASS positive <12 hours

AND

ACT FAST NEGATIVE

Answer 9

NON-ECR ELIGIBLE STROKE

• IV access 18g in large vein with reflux valve
• transport to thombolysisng stroke centre
• consider MSU
• Pre notify hospital with name, DOB and details

Question 10

What do you do if:

MASS POSITIVE <24 hours

AND

ACT-FAST positive at time of loading?

Answer 10

POSSIBLE ECR ELIGIBLE STROKE

• IV access 18g in large vein with reflux valve
• COnsider MSU

RURAL - transport to nearest VST centre

Question 11

What are the 3 categories of the MASS stroke assessment?

Answer 11

Facial droop
Speech
Hand grip

Question 12

What are the steps for the ACT FAST assessment?

Answer 12

1. ARM:
   - position arms at 45 degrees

IF one arm falls to stretcher in 10 seconds or if unable to raise arm

IF RIGHT ARM DRIFTS:

• CHAT
• > severe language deficit
• > mute
• > gibberish
• > unable to follow simple commands

IF LEFT ARM DRIFTS:

• TAP
• > tap shoulder on left side and call aptients name
• > both eyes deviate away towards right or otherwise abnormal response
• if meet eligibility criteria then ACT FAST positive confirmed

Question 13

What are the ACT FACT eligibility criteria?

Answer 13

• defecits are new or worse
• known onset <24 hours
• Living at home independently with minor assistance
• No evidence of stroke mimics