Chapter 18
For the patient with stroke to be eligible for a fibrinolytic agent, the patient must be brought to the hospital emergency department within how many hours of the onset of stroke symptoms?
2
For the patient with stroke to be eligible for a fibrinolytic agent, the therapy must be given within:
3 hours of the onset of stroke symptoms
A patient who is responsive only to painful stimuli has a patent airway, inadequate respirations at 28 breaths/min and irregular, and a strong radial pulse with skin that is warm and dry. The patient is not moving his right arm or leg and is incontinent of urine. What is the priority for the EMT at this time?
Administer positive pressure ventilation
What is the pathophysiology underlying a TIA and its typically rapid resolution?
Agents in the bloodstream bust apart the cerebral clot that is causing the signs and symptoms
A 49-year-old male patient is unable to speak. You would document this finding as:
Aphasia
When using a stroke scale to assess a patient for abnormal speech, the EMT should:
Ask the patient to repeat a specific but common phrase
When assessing a patient for a facial droop, the EMT should:
Ask the patient to show you his teeth or smile
Which of these patients would be most eligible to receive a fibrinolytic medication for stroke if no other contraindications are found?
A 48-year-old male whose symptoms started while watching the 6 p.m. news, at which time he dialed 911
The MEND exam for a stroke does not include which assessment parameter?
BGL assessment
A 78-year-old male patient was found lying on his bathroom floor. Emergency Medical Responders report that the patient is unresponsive, with unequal pupils, and vital signs are as follows: pulse, 78; respirations, 20 breaths/min and snoring; blood pressure, 210/106 mmHg; SpO2, 99%. The EMRs have applied oxygen by nonrebreather mask, and also report that the patient has a hematoma on the back of his head. What should you do first?
Ensure an open airway with a jaw-thrust maneuver
You have been called to the house of a young adult male patient who is unresponsive. The man lives by himself, so no family is present. In trying to determine the origin of the patient's altered mental status, which of these would most likely provide the best information, assuming it is available to you?
Examination of patient medications (prescribed and recreational)
To better fulfill the AHA's Stroke Chain of Survival goals, which assessment mnemonic was developed to better prepare the public and EMS to recognize stroke?
F.A.S.T.
With the Cincinnati Prehospital Stroke Scale, which of these patient parameters is assessed?
Facial droop
You have been called for a patient who suddenly became confused. Which of these assessment findings should concern you most?
Heart rate of 180 beats/min but regular
Assessment of a 63-year-old female patient reveals a patent airway, adequate breathing, and strong radial pulse. She has no difficulty speaking and no facial droop, but exhibits a slight left arm drift and has a headache. The EMT should interpret these specific findings as:
Highly suggestive that a stroke may be occurring
A patient is alert and oriented, with a blood pressure of 228/110 mmHg, a heart rate of 82 beats/min, respirations of 20 breaths/min and adequate, and a pulse oximeter reading of 96% on room air. The patient complains of a bad headache that started suddenly. The patient has equal grips and good lower leg function. The blood glucose is 68 mg/dL, and pupils are reactive, although the patient has trouble maintaining a horizontal gaze when asked to do so. He has a history of seizures, hypertension, and atrial fibrillation. Given these assessment findings, which one meets a criterion for the MEND stroke screening tool that suggests the patient may be experiencing a stroke?
Horizontal gaze abnormality
When assessing a patient with stroke-like signs and symptoms, it is critical that the EMT also suspect and rule out which condition?
Hypoglycemia
An elderly male patient with a history of COPD, hypertension, and diabetes presents as lethargic and confused. His airway is patent, and breathing is adequate. His skin is hot and his radial pulse is strong, regular, and bounding. Vital signs are pulse, 112; respirations, 20 breaths/min; blood pressure, 108/64 mmHg; SpO2, 94%; and temperature, 102.8°F. Also noted is swelling to his right lower leg. Given these assessment findings, the EMT should suspect which condition is responsible for the patient's altered presentation?
Infection
What does the first "I" in the AEIOU-TIPPSS mnemonic stand for?
Insulin
Which past medical condition identified during the SAMPLE history could be a metabolic cause of an altered mental status in an elderly male patient?
Kidney failure
A male patient suddenly found himself unable to talk and with profound weakness to his right arm and leg. Currently he is responsive to verbal stimuli and has the following vital signs: pulse, 88; respirations 14 breaths/min and adequate; and blood pressure, 210/80 mmHg. When transporting this patient to the hospital, in which position should you place him?
Left lateral recumbent
A 73-year-old female patient is responsive to painful stimuli and cannot move her arm or leg on one side of her body. You suspect she is having a stroke. What is the best transport position for this patient?
Left lateral recumbent position
A patient with a headache informs you that his physician has diagnosed him with cluster headaches. He states that his current pain feels just like the last cluster headache that he suffered. The primary assessment reveals no life threats. His vital signs are pulse, 104; respirations, 16 breaths/min; blood pressure, 124/68 mmHg; and SpO2, 98%. You note no neurologic deficits. Based on this information, what is indicated in the treatment of this patient?
Place the patient on the cot and allow him to assume a position of comfort
When assessing a patient with a suspected stroke, the order of the exam would be:
Primary assessment, then secondary assessment including a stroke scale
An alert and oriented 69-year-old male patient has slight right-arm weakness but exhibits no deficits to the right leg. The EMT should consider this patient to be a:
Priority for transport to a hospital with a stroke center
A 30-year-old patient with a history of migraine headaches has called 911 for a suspected migraine headache. She says the headache follows her usual pattern of headaches, the pain is a 10/10, and she is nauseated. Her vital signs are pulse, 108; respirations, 18 breaths/min; and blood pressure, 154/90 mmHg. Which of these treatments is indicated in the care of this patient?
Providing a darkened environment during transport
When performing a secondary assessment on an elderly male patient who is confused and combative, which of these assessment findings should be of most concern to the EMT?
Pulse of 164
A 56-year-old patient is in bed and unable to speak. Family members state that he had a stroke in the past and has been bedridden since then, but has always been able to talk, until a few hours ago when his speech became garbled. They also state that the last stroke left him paralyzed on his left side. Your assessment reveals that the patient is unable to speak, but has an open airway, adequate respirations, and a strong radial pulse. Additionally, you note that he is unable to move his right arm. Vital signs are within normal limits. What would be an appropriate step in the care on this patient?
Rapid transport to a stroke center
When assessing a patient with a possible stroke, what is the priority?
Recognizing the signs of a stroke
A patient with stroke cannot move his left arm or leg. Based on this presentation, the EMT should strongly suspect that the stroke has occurred in which part of the central nervous system?
Right side of the brain
On scene, a confused 68-year-old female patient with possible stroke has a SpO2 of 91% on room air. Regarding oxygen therapy and the adjunct by which to provide it, which of these represents the most desirable target SpO2 reading for the amount of oxygen delivered?
SpO2 95% with 2 lpm O2 via nasal cannula
You have been called to a long-term care facility for a 77-year-old female patient who was found unresponsive in her wheelchair by staff. The nurse reports that the patient complained of a headache earlier in the day and was given 600 mg of Motrin. Your assessment shows the patient to be unresponsive with a patent airway, slow and irregular respirations, and a weak radial pulse. Her lips are cyanotic, and your partner reports the following vital signs: pulse, 44; respirations, 6 breaths/min; and blood pressure, 228/116 mmHg. Which action should be your next priority?
Start positive pressure ventilation
A patient has an altered mental status accompanied by loss of motor function on one side of the body. The EMT must suspect which condition as the cause of this presentation?
Stroke
When attempting to distinguish a spinal injury from a stroke, the EMT should remember that:
Stroke typically results in weakness or paralysis to one side of the body
A male patient has altered mental status secondary to a brain tumor. The EMT would classify the brain tumor as which type of cause?
Structural
Assessment reveals a drooling 48-year-old male patient to have gurgling speech and left-arm paralysis. The EMT's immediate priority treatment is to:
Suction the airway
You are called for a 69-year-old male patient with altered mental status. Assessment reveals that he is confused and has left-sided weakness. During transport, you note that the patient is now completely oriented and the weakness has resolved. Which condition would you suspect this patient has?
Transient ischemic attack
Which of these conditions places the patient at the greatest risk for an acute neurologic deficit?
Transient ischemic attack (TIA)
You have gathered and written down all of the medications, including narcotic pain medications, that a confused 46-year-old male patient currently takes. The patient is placed on the stretcher for transport. At this time, how would you handle the medications?
Transport them with the patient
Your partner is using the AEIOU-TIPPSS mnemonic to assess for common causes of altered mental status in a geriatric patient. During this process, your partner forgets what the "T" stands for. You would remind him that it means:
Trauma
Which of these statements made by the EMT indicates a correct understanding of caring for someone with a headache?
"Assessment is essential in determining if a patient's headache represents a life-threatening condition."
Which one of these instructions to a patient with possible stroke indicates proper assessment for an arm drift?
"Close your eyes and hold your arms straight out for 10 seconds."
Which of these questions would the EMT ask when performing the Los Angeles Prehospital Stroke Screen?
"Have you ever had a seizure?"
Assessment of a 56-year-old male patient reveals him to be responsive to verbal stimuli with garbled speech. Which of these statements made by the patient's wife suggests that the patient's problem may be toxic-metabolic?
"He has bad kidneys."
The EMT shows that he is performing the Los Angeles Prehospital Stroke Screen (LAPSS) correctly when he asks which of these questions?
"How old are you?"
Which of these statements made by your new EMT partner demonstrates an understanding of assessment findings related to stroke?
"If one arm is weak, a stroke should be suspected."
Which of these statements shows that the EMT has an accurate understanding of altered mental status?
"It describes any change away from a normal state of mental function."
The EMT demonstrates she understands hemorrhagic stroke when she states:
"It occurs when a blood vessel ruptures and bleeds within the brain."
While you are teaching a public awareness class about stroke, a participant asks you if all patients with stroke are paralyzed on one side of their bodies. Your reply would be:
"No. Some stroke patients may have only slight weakness to one side of their bodies."
Which of these statements indicates that the EMT understands the appropriate use of supplemental oxygen when caring for a patient with stroke?
"Oxygen should be administered at a minimal amount, just enough to get the SpO2 at or greater than 94%."
You are obtaining the past medical history from the family of an elderly patient with an altered mental status who suffered sudden onset of right-side weakness. Which of these statements made by the patient's family member should you recognize as increasing the patient's risk of stroke?
"She has an irregular heartbeat."
Which of these statements made by a patient suggests that he is suffering from a tension headache?
"The pain seems to get worse as the day goes on."
The EMT shows that he recognizes the benefit of using the Cincinnati Prehospital Stroke Scale or Los Angeles Prehospital Stroke Screen when he makes which of these statements?
"The screening helps to identify stroke, even when it is not the patient's chief complaint."
You are treating an unresponsive patient. Which piece of information given to you by the patient's family is most important in relation to a possible stroke?
"We noticed him acting oddly about 7 p.m."
Which question would it be critical that the EMT ask the family of a patient who cannot speak and is suspected of having a stroke?
"What time did the weakness and dizziness start?"
An 82-year-old male patient presents with right-hand weakness and garbled speech. Which question should the EMT ask first to the patient or a reliable family member who is present?
"What time did these signs start?"
You have been called for a 63-year-old woman with slurred speech and right-arm weakness. On arrival, the patient informs you that the slurred speech and weakness have resolved. Since your assessment reveals no deficits, the patient insists on signing a refusal of treatment form. Which of these statements should you make prior to having her sign the form?
"You really need to be evaluated in the hospital. You are at significant risk for a future stroke, which may be debilitating or even fatal."
Rapid recognition of stroke signs and symptoms by the public is part of which assessment system?
AHA's Stroke Chain of Survival
During a continuing education program, the lecturer is talking about the RACE scale as a newer tool the EMT can use to help determine whether a neurologic problem is present. Which neurologic problem does the RACE scale address?
Large-vessel occlusion stroke
When a patient smiles, the left side of the face shows significantly less movement than the right side of the face. The EMT would describe this finding as:
Left-side facial droop
Which one of these describes the typical signs and symptoms of a transient ischemic attack (TIA)?
Temporary, with many TIAs lasting less than 15 minutes
You have determined that an alert elderly male patient has garbled speech and weakness to the right arm and leg. His vital signs and SpO2 level are within normal limits. The family informs you that he has a history of heart problems and diabetes. Given this scenario, what should you do immediately?
Check the patient's blood glucose level (if local protocol allows)
For altered mental status to occur, which body system must be affected?
Central nervous
When transporting an alert but nonverbal patient with stroke and a blood pressure of 210/110 mmHg, the EMT should:
Make an effort to explain everything that is happening or being done while trying to help the patient feel at ease
You have just arrived by the side of a 46-year-old male patient who receives dialysis for end-stage renal failure. He is positioned in his living room recliner, unresponsive with snoring respirations, and appears to have ineffective ventilations. What is your priority intervention at this time?
Manually open the airway
Which of these is a good description of an ischemic stroke?
Obstructive blood clot inside a blood vessel within the brain
A male patient is confused and combative for no apparent reason. There are no life threats to his airway, breathing, or circulation, and his vital signs are pulse, 88; respirations, 16 breaths/min and adequate; blood pressure, 144/68 mmHg; and SpO2, 93% on room air. When addressing the patient's oxygenation status, which of these treatments would be appropriate?
Oxygen at 2 lpm via nasal cannula
Which of these conditions would the EMT recognize as most likely signaling a neurologic deficit?
Paralysis
Patients with an altered mental status due to a stroke may not be able to control their own airways because of:
Paralysis or weakness of the throat muscles
A middle-aged male patient collapsed while shopping and now responds to verbal stimuli with confused speech. The primary assessment indicates no immediate life-threatening conditions. His pulse is 96, respirations 16 breaths/min, blood pressure 158/88 mmHg, SpO2 98% on room air, and blood glucose level 79 mg/dL. The patient is carrying a vial of nitroglycerin in his jacket pocket. What should you do next after determining the patient priority status?
Perform a secondary assessment
A 41-year-old female patient has called 911 for a headache. Which of these assessment findings should make the EMT suspicious that the patient has a migraine headache?
The pain was preceded by an aura
When the EMT evaluates a patient with the RACE stroke scale, the score is 3 points. This score would infer:
The patient has likely experienced a stroke
