Stroke

Question 1

Stroke risk factors
Lifestyle, cardio diseases and other

Answer 1

Lifestyle:
-smoking, alcohol, drugs, diet, lack exercise
Cardiovascular diseases
-hypertension
-AF
-valvular disease
-CAD
-congestive heart failure
-congenital heart disease
Other factors
-age(55+), gender (younger men), hyperlipidaemia, diabetes, sickle cell disease, hypercoagulable diseases, chronic kidney disease

Question 2

Stroke pathophysiology (2 types)

Answer 2

Haemorrhagic stroke (15%)
-caused by blood vessel rupture, bleeding in the brain
Ischaemic stroke (85%)
-blockage of one of the cerebral blood vessels

Question 3

Stroke-

Answer 3

-clinical syndrome characterised by SUDDEN onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours of leads to death

Question 4

Focal vs global disturbance

Answer 4

Focal- signs and symptoms causes by lesion to a specific area of the brain, specific nerve or part of spinal cord eg. face droop, limb weakness, vision loss etc.
Global- affects the whole brain eg. complete loss of consciousness, drowsiness, agitation

Question 5

Stroke signs and symptoms

Answer 5

-confusion, reduced LOC
-headache- sudden and severe
-weakness- face, limbs
-sensory loss- paraesthesia or numbness
-speech problems
-visual problems
-dizziness/ vertigo
-nausea/ vomiting
-loss of coordination
-specific cranial nerve deficits

Question 6

Hemiplegia-
Hemiparesis-

Answer 6

-paralysis of one side of the body
-weakness on one side of the body

Question 7

Stroke assessment

Answer 7

-do FAST test, if positive take to hospital if negative then do MEND test
BE FAST test
Balance- loss balance, dizziness, headache
Eyes- blurred vision
Face- ask person to smile, check face droop
Arm- ask raise arms, look for weakness
Speech- look for slurred speech
Time- call 999, go to hospital

OR

MEND (Miami emergency neurological deficit)
-on JRCALC
3 parts
-LOC/ AVPU- speech, questions (their age etc), commands (close eyes etc)
-cranial nerves- facial droop, visual fields, horizontal gaze
-limbs- motor-arm drift (close eyes ask hold arms out), sensory (close eyes and touch), coordination (finger to nose)

Question 8

Stroke treatment and management

Answer 8

-manage ABCD
-O2 if needed
-NBM- risk of choking and possible surgery
-reassure and explain- tell them you think they’re having a stroke
-guard against secondary injury- hypoxia, dehydration, hemiparesis
-assess CBG and correct if hypoglycaemic
-12 lead ECG- see if they’ve got AF which could have caused stroke
-IV access
-note anticoagulation status- on any blood thinners
-pre alert with time of onset and convey to nearest ED

Question 9

Conditions that mimic stroke

Answer 9

-hypo/hyperglycaemia
-sepsis
-migraines
-neuro abnormalities
-physiological disorders eg. anxiety
-mass lesions eg. tumour
-seuizures
-physical trauma eg. concussion