Stroke

Question 1

Recite the Stroke CPG

Answer 1

Question 2

Recite the MASS Stroke Assessment

Answer 2

Question 3

Recite the ACT-FAST Stroke Assessment for ECR Eligability

Answer 3

Question 4

What are the three components of the MASS Stroke Assessment?

Answer 4

Facial droop, Speech, Hand grip

Facial droop: ask pt to smile; abnormal if one side doesn’t move. Speech: ask pt to say “You can’t teach an old dog new tricks”; abnormal if slurred, gibberish, or unable to speak. Hand grip: ask pt to squeeze your fingers; abnormal if unilateral weakness.

Question 5

What is the first step in the ACT-FAST assessment?

Answer 5

Arm test – position arms at 45°, hold for 10 seconds. If one arm drops or is not moving, continue ACT-FAST.

Question 6

What indicates a right-sided deficit in ACT-FAST?

Answer 6

Severe language deficit (mute, gibberish, unable to follow commands)

Question 7

What indicates a left-sided deficit in ACT-FAST?

Answer 7

Eye deviation away from weak side or failure to respond to name on weak side.

Question 8

What are the ACT-FAST eligibility criteria?

Answer 8

Deficits are new or worse, Onset <24 hrs, Living independently, No stroke mimics, Not comatose or pre-comatose, BGL ≥ 2.8 mmol/L, No seizure pre-onset, No known active brain cancer, No rapid improvement

Question 9

Where do you transport if MASS Positive ≥ 12 hrs or ACT-FAST Negative?

Answer 9

Non-urgent transport to closest thrombolysing stroke centre.

Question 10

What’s the treatment plan if MASS Positive < 12 hrs and ACT-FAST Negative?

Answer 10

Insert 18G IV, Transport urgently to nearest thrombolysing centre, Consider R/V with MSU, Pre-notify hospital with clinical details

Question 11

When is a stroke patient considered ACT-FAST Positive (possible ECR)?

Answer 11

If MASS < 24 hrs AND ACT-FAST positive at time of loading.

Question 12

What’s the ECR transport protocol?

Answer 12

Insert 18G IV, Transport to ECR centre if feasible, If rural, transport to nearest VST centre and notify VST stroke physician, Otherwise, go to nearest thrombolysing centre, Pre-notify with clinical details

Question 13

When should you consider MICA and ETT for a stroke patient?

Answer 13

In all cases where airway concerns are present, consider ETT as per CPG A0302.

Question 14

What should you assess in a patient with suspected stroke or TIA?

Answer 14

Assess the following:
* Symptom onset time
* Stroke mimics
* Co-morbidities
* Perform MASS Assessment
* If <24 hours and MASS positive, perform ACT-FAST
* Assess ECG for possible AF

MASS Assessment refers to the Melbourne Assessment of Stroke Scale, and ACT-FAST is a rapid assessment tool for stroke.

Question 15

What are the Stroke mimics?

Answer 15

• Hypo/hyperglycaemia
• Seizures
• Migraine
• Sepsis
• Intoxication (drug/alcohol)
• Brain tumour
• Inner ear disorder (vertigo)
• SDH
• Syncope
• Electrolyte disturbance
• Multiple Sclerosis

Question 16

What is the definition and pathophysiology for Stroke

Answer 16

A stroke is a sudden neurological deficit caused by interruption of blood supply to the brain, leading to cell death.
It can be:

Ischaemic (≈85%): Caused by a blockage (e.g. clot or embolus)
Haemorrhagic (≈15%): Caused by bleeding into or around the brain

🧠 Types of Stroke (Dot Point Format)
Ischaemic Stroke

Caused by a blockage in a cerebral blood vessel
Commonly due to a thrombus (local clot) or embolus (travelled clot)
Accounts for approximately 85% of all strokes
Leads to reduced blood flow and oxygen to brain tissue
Often treated with thrombolysis or endovascular clot retrieval (ECR) if time-appropriate
Haemorrhagic Stroke

Caused by a ruptured blood vessel in or around the brain
Leads to bleeding, increased intracranial pressure, and tissue damage
Common causes: hypertension, aneurysm rupture, or trauma
Accounts for approximately 15% of strokes
Often requires neurosurgical intervention and supportive care