CVA

Question 1

Stroke chain of survival

Answer 1

Detection
Dispatch
Delivery
Door
Data
Decision
Drug
Disposition

Question 2

Warning signs of stroke

Answer 2

Sudden speech difficulty
Sudden weakness
Sudden visual loss
Sudden dizziness 
Sudden severe headache

Face
Arm
Speech
Time

Question 3

Pre-hospital care

Answer 3

O2, maintain >94%

Establish IV line

If hypotensive (SPB <120), IV NS

If glucose < 60, give IV glucose

Question 4

Pre-hospital assessment

Answer 4

• Time of “last known normal”
• Seizure? Trauma?
• current meds/allergies

Question 5

Things that MIMIC stroke

Answer 5

Seizures

Hypoglycemia (hx diabetes, low glucouse, decreased consciousness)

Migraine with aura (hx similar, headache)

Hypertensive encephalopathy (signif HTN, cortical blindness, seizure)

Wernicke’s encephalopathy (hx alcoholism, ataxia)

CNS abscess (hx drug abuse, medical device implant, fever)

CNS tumor (gradual progression, seizure at onset, mets)

Question 6

Initial evaluation stroke

Answer 6

ABCs

Assess neuro deficits and comorbidities

Identify anything needing immediate intervention

Determine possible causes

Early intervention of stroke pathways

Question 7

Patient Hx

Answer 7

most important: TIME OF SYMPTOM ONSET

Risk factors for artherosclerosis 
Drug / alcohol abuse
Migraine
Seizure
Infection
Trauma
Pregnancy

Question 8

PE for stroke

Answer 8

ABCs

Vitals / O2

Trauma survey

Neck and carotids for bruits, JVD

Heart and lungs (murmurs, arrhythmias, rales)

Skin (bruising, platelet disorders, trauma, embolic lesions)

Neuro exam and Stroke Scale

Question 9

Immediate diagnostics for all pts w suspected stroke

Answer 9

Noncontrast CT or MRI

Glucose

O2 sat

CMET (electrolytes, BUM, SrCR)
CBC
PT/INR, PTT

Cardiac enzymes
EKG

Question 10

rTPA inclusion criteria

Answer 10

< 3 -4.5 hrs sx onset

Dx ischemic stroke causing neuro deficits

Age > 18yrs

Question 11

rTPA exclusion criteria

Answer 11

Significant head trauma < 3 months before stroke

anything suggesting any kind of bleed / puncture / hemorrhage
Recent brain / spine surgery

Heparin received w/i 48 hours → aPTT > ULN
Current anticoagulant (INR >1.7 or PT >15 secs)
Current use of direct thrombin inhibitors or direct factor Xa inhibitors

Aneurysm
Brain tumor