Neuro

Question 1

Alteplase window

Answer 1

4.5 hours

Question 2

Extended alteplase window

Answer 2

> 4.5 hours, may be appropriate for wake up stroke or unknown last known well and lesion smaller than 1/3 of mca territory

Question 3

Evaluation for mechanical thrombectomy

Answer 3

• 6-24 hr window
• large vessel occlusion anterior circulation
• obtain CT perfusion or diffusion weighted MRI to determine eligibility
• if<6 hr thrombectomy preferred over additional imaging

Question 4

Bp goal to give alteplase

Answer 4

<185/110

Question 5

Permissive HTN with CVA

Answer 5

If not receiving alteplase or thrombectomy
Goal <220/120
Lower by 15% in first 24 hours

Question 6

DAPT after CVA

Answer 6

Use for minor CVA/TIA (NIHSS <3)

- ASA and Plavix for 21 days

Question 7

BE FAST

Answer 7

Balance
Eyes- change in vision
Face
Arms- weakness, numbness, drift
Speech (or understanding)
Time (if last known well <12 hrs activate)

Question 8

FAST-ED tool decision

Answer 8

Use for stroke symptoms 12-24 hrs

• if score >/=4 call stroke alert, assume LVO
• > /=4 gives 60-85% chance LVO
• <4 get imaging and neuro IR if LVO

Question 9

FAST-ED score

Answer 9

• more specific for cortical signs and helps determine LVO
• facial palsy
• arm weakness
• speech changes
• eye deviation
• denial/neglect

Question 10

IV size for stroke

Answer 10

18g to give alteplase if needed

Question 11

Goal time to CT

Answer 11

20 min, ideal <15

Question 12

Goal time to alteplase

Answer 12

45 min

Question 13

Post-thtombotic bp goal

Answer 13

<180/105

Question 14

Hemorrhagic stroke bp guidelines

Answer 14

ICH SBP <100-140

aSAH SBP U160

Question 15

Order sets stroke

Answer 15

• acute ischemic stroke +/- alteplase
• acute hemorrhagic stroke
• anticoagulant reversal
• alteplase admission
• inpatient stroke alert