Brain Attack (Stroke) - Unit 3

Question 1

What is a stroke?

Answer 1

It’s a cut off of blood supply to a part of the brain.

Question 2

What are the two types of strokes?

Answer 2

Ischemic and Hemmorhagic

Question 3

Strokes - higher in whites than blacks. T/F?

Answer 3

FALSE - Higher in blacks than whites.

Question 4

Strokes kill almost ____ americans each year.

Answer 4

130,000

Question 5

Stroke - leading cause of long-term disability. T/F?

Answer 5

True

Question 6

Stroke care - Time lost = brain lost. T/F?

Answer 6

True

Question 7

There is a high chance in reoccurrence of a stroke right after it has happened. T/F?

Answer 7

True

Question 8

What does FAST stand for?

Answer 8

FACE.
ARMS.
SPEECH.
TIME.

Question 9

What are some stroke risk factors that cannot be controlled?

Answer 9

Increasing age, gender (more women than men, especially after menopause), heredity and race, prior stroke, genetics.

Question 10

What are some modifiable risk factors?

Answer 10

High blood pressure, cardiac disease (A-Fib?), lipids, diabetes, tobacco use, illegal drug use, life style factors

Question 11

Stroke exam - worst headache ever?

Answer 11

Yes!

Question 12

What are some diagnostic tools for stroke?

Answer 12

CT Scan with or without contrast (first stop on the diagnostic train!),
CTA, Mri, carotid doppler, EEG, EKG, ECHO, etc.

Question 13

What is a TIA?

Answer 13

Transient Cerebral Ischemia - it’s a mini stroke that usually goes away after 24 hours.

Question 14

What does a TIA signal?

Answer 14

A very high change of impending stroke.

Question 15

Is there permanent damage with a TIA?

Answer 15

Nope!

Question 16

What are two types of Ischemic Strokes?

Answer 16

Thrombotic and Embolic

Question 17

Thrombotic Stroke - def
When does it typically happen?
Risk factors?

Answer 17

This is when a blood clot cuts off supply to the brain - it’s a thrombus. It typically happens during sleep.
Risk factors are large vessels, HTN

Question 18

Embolic Stroke - def
What’s the onset?
Risk factors?

Answer 18

This is when a clot or fragment breaks loose, say from the heart, and travels to the brain.
It has a very quick onset.
Risk factors include endocarditis, A-Fib.

Question 19

What is the ischemic cascade?

Answer 19

This is a series of biochemical reactions in the brain after ischemia is found. Like, no atp? –> anaerobic –> lactic acid, etc.

Question 20

What are the major interventions for Ischemic Stroke?

Answer 20

We want to reestablish flow/rescue the ISCHEMIC PENUMBA

Question 21

What is the Ischemic Penumbra?

Answer 21

Ok, so when someone has an ischemic stroke, there’s like a ball that forms around the tissue. The outer layer of the ball is dead, but for the next 3-6 hours, the inside of the ball is alive. After that period, the inside dies as well. We want to save as much as we can.

Question 22

What drugs do we give for an ischemic stroke?

Answer 22

Antiplatelet therapy (Aspirin - given right away), Plavix)
or Thrombolytic Therapy (TPA)

Question 23

TPA - What is it used for? What’s important to know about it?

Answer 23

It’s for a block and it breaks the clot up. There’s a lot you have to cover with it - it is not for everyone (especially people with high BP, seizures, etc.) Also, it can be given only up to 3 hours after surgery. So, if the person wakes up with a stroke, they can’t get TPA because we don’t know about the timing.

Question 24

Are there surgical options for the prevention of stroke?

Answer 24

There’s a carotid ultrasound and carotid endarterectomy, which is taking the plaque out of the artery.!

Question 25

With a carotid endarterectomy, what is recovery like?

Answer 25

well since we’ve messed with their carotids, the baro/chemo receptors might get all out of whack so they may have some BP/HR problems. Staying overnight in a hospital tends to help this.

Question 26

What are the three types of hemorrhagic stroke? Caused by or extension of…

Answer 26

Intracerebral Hemorrhage (ICH), caused by hypertension, cocaine, etc.

Intraventricular Hemorrhage (IVH), which is an extension of an ICH. This is not good.

Subarachnoid Hemorrhage (SAD) - caused by a ruptured aneurysm.

Question 27

What is an aneurysm?

Answer 27

It’s a blood vessel that burst.

Question 28

What are some common areas for an aneurysm?

Answer 28

The circle of willis/middle cerebral.

Question 29

Once an aneurysm bleeds, there’s a 30-40% chance of death. T/F?

Answer 29

True

Question 30

What’s a vasospasm in regards to an aneurysm?

Answer 30

Rebleeding/rupturing (Nimotop can help this!)

Question 31

How can we manage an aneurysm?

Answer 31

Interventional radiology/coiling

Question 32

With an aneurysm, is maintaining an equal I/O important?

Answer 32

yes

Question 33

What is coiling?

Answer 33

This is when they put a coil - like this metal stuff - into an aneurysm. It blocks blood from coming!

Question 34

Stroke scoring system - >20 = what?

Answer 34

BAD

Question 35

What do we do in an assessment for stroke?

Answer 35

ABC’s, Level of consciousness, BP, symptom onset, correlate deficit with vascular distribution, area of brain, etc.

Question 36

What’s part of the clinical picture for stroke management?

Answer 36

Focused neurological examination, ABCD (Airway, Breathing, Circulation, Disability), IV access, frequently monitor patient’s vitals (BP is super important), noromothermia, normal glycemic control, fluid resuscitation, imaging, evaluation for thrombolytic therapy, maintain a good airway, prevent secondary brain injury, etc.