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E1 E2 Paramedic Science > TIA/CVA > Flashcards

TIA/CVA Flashcards

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1
Q

Define Transient Ischaemic Attack (TIA)

A

A disorder of the brain in which brain cells temporarily stop working because of insufficient oxygen, causing stroke like symptoms that resolve completely within 24hrs

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2
Q

Define Cerebral Vascular Attack (CVA)

A

Rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24hrs

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3
Q

2 main types of CVA?

A

Ischaemic and Haemorrhagic

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4
Q

Ischaemic CVA:

A
  • Brain tissue dies from lack of blood

- Three subtypes: Embolic, Thrombus and Watershed

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5
Q

(Ischaemic) Embolic CVA

A
  • A clot formed elsewhere in the body, moves through the blood vessels and lodges in the cerebral circulation
  • May be caused by other emboli such as bone fragments or air bubbles
  • Common in people with varicose veins
  • Common in people with clotting disorders
  • Increased risk following long periods of immobility
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6
Q

(Ischaemic) Thrombus CVA

A
  • Occurs when a blood clot forms in the blood supply of the brain
  • Occurs most frequently in people suffering atherosclerosis or clotting disorders
  • Often show sudden onset of symptoms
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7
Q

(Ischaemic) Watershed CVA

A
  • Atherosclerotic deposit in carotid artery significantly decreases the total blood flow to the brain
  • Decreased blood flow = decreased oxygenation = hypoperfusion and cell death
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8
Q

Haemorrhagic CVA

A
  • Blood vessel ruptures
  • Common in people with high blood pressure
  • Sudden onset of symptoms
  • Leaked blood acts as a toxic liquid, damaging further areas of the brain
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9
Q

Transient Ischaemic Attack (TIA)

A
  • Temporary disruption in blood flow to the brain, resolving in 24hrs
  • Resolved by clot dispersing or new neurons taking place of the damaged ones
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10
Q

Signs and Symptoms of CVA/TIA

A
  • Difficulty in speaking/ slurred speech
  • Limb power reduced/ absent
  • Facial droop
  • May have difficulty understanding speech
  • Blurred vison
  • Severe headache
  • Sensation may be affected
  • Dilated pupil
  • Altered consciousness
  • Convulsions
  • BP- usually raised
  • Hemiplegia
  • Assessment tools – FAST, MEND, ABCD2
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11
Q

Risk Factors for CVA/TIA

A
  • Hypertension
  • High cholesterol
  • Smoking
  • Diabetes

(History of TIA, atherosclerosis, hypertension, AF, arrhythmias, rheumatic heart disease, diabetes, orthostatic hypotension, cardiac enlargement, lack of exercise, drug abuse, smoking, family history, sickle cell disease)

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12
Q

Differentials to consider for CVA/TIA

A
  • Bells Palsy
  • Hypoglycaemia
  • Overdose
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13
Q

Assessment for CVA/TIA

A

DRA(c)BCDE

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14
Q

DANGER assessment for CVA/TIA

A

Record time of onset?
- Assess for any potential dangers
- Manage any bleeds
Evaluate if the patient has any time-critical features. FAST positive test.

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15
Q

RESPONSE assessment for CVA/TIA

A

AVPU - assess

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16
Q

AIRWAY assessment for CVA/TIA

A
  • Clear?

- Correct if compromised

17
Q

C-SPINE assessment for CVA/TIA

A

Is there a concerned based on MOI

18
Q

DISABILITY assessment for CVA/TIA

A
  • Blood glucose – rule out a hypo
  • Temperature?
  • PEARL?
  • Equal and bilateral air entry?
  • 12 lead ECG look for AF
    • Altered GCS Assess Glasgow Coma Scale (GCS) on unaffected side - eye and motor assessments may be more readily assessed if speech is badly affected.
19
Q

EXAMINATIONS assessment for CVA/TIA

A

Expose and examine for any potential injuries

20
Q

BREATHING assessment for CVA/TIA

A
  • Rate and depth of respiration?

- Assist with ventilation if required

21
Q

CIRCULATION assessment for CVA/TIA

A
  • Heart rate?
  • Palpable radial pulse?
  • Oxygen saturations?
  • Capillary refill?
  • Blood pressure?
  • Correct if necessary
22
Q

History

A
  • When did it start?
  • Has this happened before?
  • Medications for anti-platelets or anti-coagulants.
23
Q

Treatment for CVA/TIA

A

As per JRCALC
Correct any ABC problems immediately
Pre-alert hospital with onset time and convey to A&E with continuous monitoring, treatment and reassessment
Oxygen therapy if saturations are below 94%
Would like to see consideration of transport to stroke unit/thrombolysis if available.
Manage convulsions with diazepam if required.
Keep normo-Glycaemic.

On-route continue patient management.

Suspected acute stroke – a positive FAST test should be considered a Time Critical condition. Perform a brief secondary survey but do not delay transport to hospital:

24
Q

Quick overview of FAST test

A

(Face, Arms, Speech, Time)
Assessment of speech, dysphasia, (receptive, expressive, global) dysarthria. Assessment of all 4 limbs for power and sensation.

E1 E2 Paramedic Science (8 decks)

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