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