*strokes*

Question 1

What is a cerebrovascular accident?

Answer 1

obstruction or rupture of an artery in the brain!!

Question 2

What are the two types of risk factors in terms of why we have intracranial hemorrhage?

Answer 2

non modifiable
modifiable

Question 3

What are modifiable risk factors?

Answer 3

High blood pressure
High cholesterol (lipid medications)
Cigarette smoking (Birth control >35 yrs old + smoking= higher risk)
TIA
Heart disease
Diabetes mellitus

Question 4

Non-modifiable risk factors?

Answer 4

Age
Gender
Race
Prior stroke
Hereditary (high cholesterol)
Hypercoagulopathy (blood clot easily- autoimmune diseases)
High RBC and sickle cell anemia

Question 5

What is the circle of willis???

Answer 5

collateral blood flow
- scalp vessels, vessels of the dura and arachnoid

Question 6

What does occlusion of the circle of willis result in?

Answer 6

infarct and ischemia

Question 7

What is cerebral blood flow?

Answer 7

auto regulation of the cerebral vessels

Question 8

How is perfusion in the arteries regulated? By what two things?

Answer 8

Oxygen and glucose

Question 9

Ischemia and acidosis are VASO_____!!

Answer 9

dilators

Question 10

What are the types of strokes?

Answer 10

ischemic and hemorrhagic

Question 11

What are ischemic strokes?

Answer 11

occlusion of an artery from plaque buildup (high cholesterol- greasy food)

embolus causing sudden obstruction
(thrombi may break off)

Question 12

S/S of an ischemic stroke?

Answer 12

Hemiparesis or Hemiplegia (contralateral)
Numbness (contralateral) and facial drooping
Aphasia (unable to speak)
Confusion or coma
Convulsions
Incontinence
Diplopia (double vision)
Dysarthria (slurred speech)
Headache, dizziness

Question 13

What is a thrombus?

Answer 13

blood clot

Question 14

What is an embolus?

Answer 14

obstruction of blood flow due to a mass of undissolved matter lodging in a vessel

Question 15

What are hemorrhagic strokes?

Answer 15

blood vessel of the brain has BLOWN

Question 16

Which is more fatal ischemic or hemorrhagic strokes?

Answer 16

HEMORRHAGIC!!
- rapidly fatal cannot go in and stop bleeding
- less common

Question 17

What is a cerebral embolus?

Answer 17

occlusion of an intracranial vessel from a fragment of a foreign substance

Question 18

What are some causes of cerebral embolus?

Answer 18

atherosclerotic plaque

GAFT
gas embolus- diving injuries
air embolism- after thoracic surgery
fat embolism- after long bone injuries
thrombi- valvular heart disease and A FIB

Question 19

What are causes of hemorrhagic strokes?

Answer 19

cerebral aneurysms
AV (arterial venous) malformations
hypertension
stress/ exertion
cocaine or other sympathomimetic drugs

Question 20

What are s/s of hemorrhagic strokes?

Answer 20

sudden onset accompanied by headache, nausea, vomiting, and quick deterioration

Question 21

What does TIA stand for?

Answer 21

transient ischemic attacks

Question 22

What IS a TIA?

Answer 22

focal cerebral dysfunction- temporary reduction in blood flow!

Question 23

How long to TIA’s typically last?

Answer 23

mins-hours
rarely lasts more than 1-2 hours
recovery in 24 hrs
pt returns to normal

Question 24

What are s/s of TIA’s?

Answer 24

Related to location of ischemia
Weakness
Paralysis
Numbness of the face
Speech disturbances
Result from a vascular disturbance

Question 25

What are specific assessments we can do for these patients?

Answer 25

Facial droop (get them to smile)
Leg weakness / drift
Arm weakness / drift
Slurred speech, inappropriate words or mute “is this the way they normally talk”
Pupils

Question 26

What are the contraindications of acute stoke bypass protocol??

Answer 26

CTAS 1
Symptoms resolved prior to medic arrives
Blood sugar <3mmol/L
Seizure at onset of symptoms
GS<10
Terminally ill or palliative care pt
Duration of transport to stroke hospital exceeds 2 hours

Question 27

Pt must be presenting with ALL of the following in order to bypass to stroke centre…..

Answer 27

present NEW onset with one of the following:
- unilateral arm/leg weakness or drift
- slurred speech or inappropriate words or mute
- unilateral facial droop

time to arrive is within 6 hours of clearly determined time of onset of symptoms

perform LAMS - inform dispatch to aid in destination

Question 28

Assessment and treatment for STROKES:

Answer 28

• Airway assessment and breathing
• History
  Previous disorders (high cholesterol,
  diabetes)
• Medications (ace inhibitors, blood thinners,
  etc)
• Initial symptoms and progression
• Precipitating factors
• Muscle tone and sensation

LAMS score- Los Angeles Motor Score
Recognizes large vessel occlusion

Question 29

Management of CVA’s:

Answer 29

Management
Airway
Suctioning and positioning
Breathing
IPPV, oxygenation
Circulation
Monitor BP and ECG
I.V. (start IV in unaffected side)

Positioning – supine with head elevated 15 degrees= airway protection
Protect extremities, careful transport, comfort and reassurance
Communicate with family!!!