Stroke CPG Notes

Question 1

What are the three primary care objectives for stroke/TIA patients?

Answer 1

Assess suspected stroke/TIA using MASS
Transport to appropriate destination (thrombolysis, ECR, or neurosurgical centre)
Hospital pre-notification

MASS refers to the Melbourne Ambulance Stroke Screen.

Question 2

Which patients does the stroke/TIA CPG apply to?

Answer 2

Any patient who has had neurological signs or symptoms (whether resolved or not) that may be a stroke or TIA.

CPG stands for Clinical Practice Guidelines.

Question 3

If a patient still has symptoms but they’re improving, should you still suspect stroke?

Answer 3

Yes, stroke should still be suspected if symptoms are present at time of assessment.

Question 4

When is oxygen therapy indicated in stroke patients?

Answer 4

If SpO₂ < 92%, as per CPG A0001 Oxygen Therapy.

Question 5

Name at least five stroke mimics.

Answer 5

• Hypo/hyperglycaemia
• Seizures
• Migraine
• Sepsis
• Intoxication (drugs/alcohol)
• Brain tumour
• Inner ear disorder (vertigo)
• Subdural haematoma
• Syncope
• Electrolyte disturbance
• Multiple sclerosis

Question 6

How should you transport nursing home patients with stroke symptoms?

Answer 6

Code 2 without hospital pre-notification, as they are unlikely to be thrombolysis candidates.

Question 7

Do other co-morbidities rule out thrombolysis?

Answer 7

No, they do not necessarily exclude it. Their urgency and history should be discussed with hospital during notification.

Question 8

How is TIA diagnosed?

Answer 8

Only via hospital investigation.

Question 9

Should suspected TIA patients be transported?

Answer 9

Yes, all suspected TIA patients should be transported.