Stroke

Question 1

If EMS suspects a stroke, what should they have completed prior to arrival to ED?

Answer 1

1. Assess ABCs/02 if necessary
2. Perform physical exam with a validated stroke screening tool
3. Establish time of onset of S/S
4. Check BS

Question 2

Your patient arrives with a suspected stroke, what are the first few steps you will complete as the nurse?

Answer 2

1. activate stroke team
2. prepare for emergent CT scan or MRI of the brain
3. assess ABCs/02
4. IV access
5. check BS
6. review hx, medications, and procedures
7. establish time of symptom onset
8. NIH stroke scale

*best practice is to bypass ED –> brain imaging suite

Question 3

S/S of a stroke

Answer 3

S/S: sudden weakness/numbness of face/arm/leg unilateral, trouble speaking/understanding, vision changes- difficulty seeing, trouble walking, loss of balance, HA, and confusion

Question 4

Within how many minutes should the MRI/CT scan be completed?

Answer 4

20 minutes and interpretation within 45 minutes

Question 5

What is the most important result of the scans?

Answer 5

To determine if stroke is hemorrhagic or ischemic (more common)

Question 6

When do we give fibrinolytic? What is the time frame of this medication? Parameters?

Answer 6

ONLY with ischemic strokes
-want to administer fibrinolytic within 60 minutes
-can give between 4- 4.5 hrs of onset of S/S
-BP must be 185 or less/110 or less

Question 7

With ischemic strokes, what would we consider after administering fibrinolytics? Time frame?

Answer 7

EVT or endovascular therapy
-Can do this procedure up to 24 hrs within onset of s/s. Goal time is 90 minutes.