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