Stroke CPG

Question 1

what are the care objectives?

Answer 1

Transport to appropriate destination (thrombolysing, ECR or nearlogical stroke)
hospital pre-notification
assess suspected TIA/stroke using MASS

Question 2

what are the stroke mimics?

Answer 2

Hypo/hyper glycemic
sezires
sepsis
intoxication
brain tumour
inner ear disorder
subdural heamatoma
syncope
migraine
electrolyte disturbance

Question 3

what are the significant co-morbidities for stroke?

Answer 3

Dementia

significant pre-existing disability

Question 4

when is an inter cranial heammorage more likely the cause than schematic stroke?

Answer 4

Rapid deterioration
complaint of severe headach
nausea/vomitting
bradycardia/hypertension

Question 5

where should awake/comatose suspected ICH paitents be transported?

Answer 5

awake- transport to nearest stroke hospital
comatose- metro- neurosurgical centre
rurual- hems vs time to stroke centre

Question 6

what is the eligibility timeframe for thrombolysis?

Answer 6

12 hours from symptom onset

Question 7

what is the time frame for endovascular clot removal?

Answer 7

24 hours from onset of symtoms

Question 8

what do we asses initally for suspected stroke or TIA?

Answer 8

Determine symptom onset time
consider minimcs
consider co-morbidities
MASS assesment - if positive <24 hrs perform act-fast
Asses ECG for possible AF

Question 9

what do we do if the paitent is MASS positive over 12 hopurs and act-fast negative or suspected TIA?

Answer 9

transport to closest stroke centre

Question 10

what do we do if the paitent is mass positve less tthan 12 hours and act-fast negative?

Answer 10

IV acess- 18g in large vein with reflux valve
transport urgently to nearest thrombolysisng stroke centre
consider R/V with mobile stroke unit
pre-notify hospital with clinical details, name and DOB

Question 11

what do you do if the paitent is MASS positive <24 hours and ACT-FAST positive?

Answer 11

Possibility for ECR
IV acess- 18g
consider r/v with stroke unit
transport urgently to nearest thrombolysisng stroke centre
pre-notify hospital with clinical details, name and DOB

Question 12

what are the 5 grades of subarachnoid hemorrage?

Answer 12

1- mild headache without meningeal iritation
2- sevre headahce and nonfocal examination
3- mild alteration in neurological examination
4- obvious depressed level of conciousness
5- paitent either posturing or comatose

Question 13

what are some clues that may suggest a heamoraagicce or ischemic strone?

Answer 13

heamorragic- sudden oneset, headache, progression to coma

ischemaic- in afib, heart disease, clotting disorder

Question 14

what is the result of damage to the cerebellum?

Answer 14

dizziness, loss of balance, loss of cordination, slurred speach, nausea and vommiting

Question 15

what are some signs that there is damage to the brainstem?

Answer 15

coma, total paralysis to both sides, problems swallowing, double vision, nausea and vomitting, hiccups

Question 16

how many stroke occurs after a TIA?

Answer 16

15%

Question 17

what is the definition of a TIA?

Answer 17

Blood supply is temporarily blocked to the brain- and after it is restored function is restored

Question 18

what are the controlable risk factors for a stroke?

Answer 18

high blood pressure
high cholesterol
diabetes
tobacco use
alchol use
physical inactivity
obesity
heart diseas
atrial fibrilation

Question 19

what are the non-controlable risk factors for stroke?

Answer 19

age, gender, race, family histy, previous stroke or TIA

Question 20

what is the goal of stroke managemt?

Answer 20

confirm diagnosis, identify and treat cause, early rehabilitation, relevant education to prevent second episode or complications