ACLS Acute Stroke Care
Anticoagulants or antiplatelet treatment should not be administered for __________ hours after administration of rtPA.
24
A neurological assessment and CT scan should be completed within ______ minutes of ED arrival.
25
For inclusion of fibrinolytic therapy, the onset of symptoms must be less than _____________hours before beginning treatment.
3
From the time of onset of symptoms for ischemic stroke, how long do you generally have to initiate fibrinolytic therapy?
3 hours
In certain instances, the time allowed for consideration of treatment can be pushed back to ______ hours after onset of symptoms.
4.5
Interpretation of the CT scan should be completed within _________ minutes of ED arrival.
45
Intra-arterial administration of rtPA, which is not yet approved by the FDA, can be given within the first _______ hours after onset of symptoms and has been documented to improve functional outcomes.
6
For patients who qualify for fibrinolytic therapy, it should be initiated within _____ minutes of hospital arrival.
60
What should not be given until intracranial hemorrhage has been ruled out? (3)
-aspirin -heparin -rtPA
Monitor blood pressure as follow after rtPA therapy
-every 15 minutes for the first 2 hours -every 30 minutes for 6 hours -every 1 hr for 16 hours
What will exclude someone from fibrinolytic therapy?
-head trauma or stroke in the last 3 months -symptoms or history of cerebral hemorrhage -arterial puncture at a non-compressible site within 7 days -systolic BP >185 or diastolic >110 -any bleeding present on examination -any predisposition to bleeding (platelet count less than 100,000; received heparin within 48hrs with elevated aPTT; current use of anticoagulants and INR >1.7 or PT>15 sec) -blood glucose less than 50 -CT show multilobar infarction
The minimum age for inclusion of fibrinolytic therapy is __________ years of age.
18
Hemorrhagic strokes are potentially eligible for fibrinolytic therapy. (T or F?)
F
Hemorrhagic stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding cerebral tissue. (T or F?)
T
The correct order of the 8 D's of stroke care is:
detection, dispatch, delivery, door, data, decision, drug, disposition
If hemorrhage is not present on the initial CT scan and the patient is not a candidate for fibrinolytics for other reasons, consider giving what medication?
aspirin
The Cincinnati Prehospital Stroke Scale identifies a stroke on the basis of these three physical findings:
facial droop, arm drift, abnormal speech
The most common form of stroke is:
ischemic
The critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a ________________.
non contrast CT scan
Upon arrival to the ED, how soon should a suspected stroke patient receive an assessment and order for a non-contrast CT scan?
within 10 minutes