Strokes

Question 1

Stroke

Answer 1

Occurs when blood flow is either cut off or reduced, depriving the brain of blood and oxygen

Question 2

Ischemic stroke

Answer 2

Makes up 87% of strokes

Caused by a blockage in an artery stopping normal blood and oxygen flow to the brain.

Question 3

Two types of ischemic strokes

Answer 3

Embolism
Thrombosis

Question 4

Embolism

Answer 4

Type of ischemic stroke where a blood clot or plaque fragment from elsewhere
in the body gets lodged in the brain

Question 5

Thrombosis

Answer 5

Type of ischemic stroke where a blood clot is formed in an artery that
provides blood to the brain

Question 6

Blood clot

Answer 6

Mass of blood that forms when platelets, proteins and cells in the blood stick together to stop bleeding.

When the bleeding stops, the body breaks down and removed the blood clot

Blood clots not forming where they should, or too many blood clots, or abnormal blood clots are dangerous

Question 7

Deep vein thrombosis (DVT)

Answer 7

Blood clot in deep vein usually in the lower leg, thigh, or pelvis. It can block a vein and cause damage to your leg.

Question 8

Pulmonary Embolism (PE)

Answer 8

When the DVT clot breaks off and travels through the bloodstream to the lungs, and can damage the lungs and prevent organs from getting oxygen

Question 9

Symptoms of blood clots

Answer 9

In the abdomen: Abdominal pain, nausea and vomiting

In an arm or leg: Sudden or gradual pain, swelling, tenderness, and warmth

In the lungs: Shortness of breath, pain with deep breathing, rapid breathing, and increased heart rate

In the brain: Trouble speaking, vision problems, seizures, weakness on one side of the body, and sudden severe headache

In the heart: Chest pain, sweating, shortness of breath, and pain in the left arm

Question 10

Stroke from large vessel occlusion (LVO)

Answer 10

A more severe type of ischemic stroke occurs when a major artery in the brain is blocked.

Affects up to 46% of acute ischemic stroke

Caused by blockages in the internal carotid artery, middle cerebral artery, or basilar artery

Question 11

Aneurysm

Answer 11

Occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen.

Can develop over many years and often have no symptom

When it ruptures, it can serve as a problem

Question 12

Hemorrhagic stroke

Answer 12

Caused by breakage of blood vessel within the brain due to bleeding

13% of strokes caused by hemorrhage

Can be result of ruptured aneurysm

Question 13

Aortic aneurysm

Answer 13

occurs in the main artery carrying blood from the heart to the body.

Question 14

Cerebral aneurysm

Answer 14

occurs in an artery of the brain.

Question 15

Two types of hemorrhagic stroke

Answer 15

Intracerebral hemorrhage
Subarachnoid hemorrhage

Question 16

Intracerebral hemorrhage

Answer 16

Bleeding within the brain itself. This occurs when an artery in the brain bursts and floods the surrounding tissue with blood.

Question 17

Subarachnoid hemorrhage

Answer 17

Occurs when a blood vessel bursts near the surface of the brain and blood
pours into the area outside of the brain, between the brain and the skull

Question 18

Transient Ischemic Attack (TIA)

Answer 18

Caused by blockage, but is temporary and caused no permanent damage to the brain

Question 19

Thromolysis

Answer 19

treatment that uses medications to break down blood clots in blood vessels and prevents new clots from forming

Used to treat heart attacks, PE, and stroke, and blood clots from DVT or PAS

Patient must receive thrombolysis, 0-3 hrs from symptom onset

Question 20

Common Right-Sided Hemisphere Stroke symptoms

Answer 20

Dysarthria - Slurred speech
Weakness or numbness of the left side of face, arm, or leg
Right gaze preference

Question 21

Systemic Hypoperfusion

Answer 21

A general decrease in blood supply, e.g., in shock)

Possible cause of stroke

Question 22

Cryptogenic stroke

Answer 22

Stroke without obvious explanation

This happens in 30-40% of ischemic strokes

Question 23

Left-Sided Hemisphere Stroke

Answer 23

• Speech problems: inability to get words out
• Comprehension problems
• Weakness of numbness of the right side of face, arm, or leg
• Left gaze preference

Question 24

Brainstem stroke

Answer 24

• Nausea, vomiting, or vertigo
• Speech problems
• Swallowing problems
• Abnormal eye movements
• Decreased consciousness
• Crossed findings

Question 25

CT scan

Answer 25

type of imaging that uses X-ray techniques to create detailed images of the body.

Question 26

MRI scan

Answer 26

a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. Can be used to identify anatomical position of tumor and tissue changes in stroke and epilepsy

Question 27

Epilepsy

Answer 27

a chronic brain disease that causes recurring seizures, which are brief episodes of involuntary movement.

Question 28

Contraindications to thrombolysis

Answer 28

- Severe recent or acute head trauma * Recent intracranial/intraspinal surgery * History of intracranial hemorrhage * Recent GI malignancy or bleeding * Blood clotting impairment * Recent treatment with heparin * Taking anticoagulant * Known or suspected aortic arch dissection

Question 29

Anticoagulants

Answer 29

Medicines that prevent or slow blood clotting Used to lower risk of serious conditions such as strokes or heart attacks Also known as blood thinners

Question 30

Goal of stroke care

Answer 30

Minimizes brain injury and maximize the patient’s recovery

Question 31

Stroke Chain of Survival links

Answer 31

1, Family member, friend or bystander recognizes stroke warning signs and rapidly calls 9-1-1 2, EMS rapidly arrives at scene and performs stroke assessment 3,. EMS rapidly notifies receiving hospital that patient will be arriving and EMS transports patient to the receiving hospital 4. Hospital rapidly diagnoses and treats patient

Question 32

Hospital levels of care

Answer 32

Acute Stroke Ready Hospital (ASRH) Primary Stroke Center (PSC) Thrombectomy-capable Stroke Center (TSC) Comprehensive Stroke Center (CSC)

Question 33

Acute Stroke Ready Hospital (ASRH)

Answer 33

* Stabilize the patient & provide IV thrombolysis if appropriate * Transfer most patients to a CSC, TSC or PSC * Frequently rely on telestroke for neurology expertise

Question 34

Primary Stroke Center (PSC)

Answer 34

* Stabilize patient and provide IV thrombolysis if appropriate * Either admit or transfer to a CSC * Most common type of stroke center

Question 35

Thrombectomy-capable Stroke Center (TSC)

Answer 35

* Meet all criteria of a PSC, including administering IV thrombolysis if appropriate * Also provide mechanical thrombectomy (MT) for stroke patients with large vessel occlusion (LVO)

Question 36

Comprehensive Stroke Center (CSC)

Answer 36

* Have the capability to support all needed levels of care to all types of stroke patients, including hemorrhagic stroke: o Provide IV thrombolysis and/or MT for ischemic stroke patients when appropriate o Full complement of stroke neurology, critical care, & neurosurgical personnel & infrastructure o Special interventions o Highly technical procedures

Question 37

EMS Assessment and Management

Answer 37

* Support ABCs: airway, breathing, circulation. Give oxygen if needed. * Perform prehospital stroke assessment using a prehospital stroke screening tool. * Establish time when patient was last normal; interview family members or witnesses, if needed. * Identify if patient has significant pre-stroke disability. * Identify current medications, especially anticoagulants, and obtain patient history including co-morbid conditions (e.g. recent surgery, procedures or stroke) that may impact treatment decisions. * Provide advance notification to receiving hospital as soon as possible of potential stroke patient “CODE STROKE.” * Check glucose level if possible.

Question 38

Where to transport when a LVO Stroke is suspected:?

Answer 38

Comprehensive Stroke Center (CSC) or Thrombectomy-capable Stroke Center (TSC) within 45 minutes of max transport time

Question 39

Cincinnati Prehospital Stroke Scale

Answer 39

Facial Droop: Have patient look up at you, smile and show their teeth. Normal: Left and right side of face move equally Abnormal: One side of face does not move at all Arm Drift: Have patient lift arms up and hold them out with eyes closed for 10 seconds. Normal: Both left and right arm move together or not at all Abnormal: One arm does not move equally with the other Speech: Have patient say a simple sentence, i.e. “You can’t teach an old dog new trick Normal: Patient uses correct words with no slurring Abnormal: Patient has slurred speech, uses inappropriate words or cannot speak If any 1 of these 3 signs is abnormal, the probability of stroke is 72% If all 3 findings are present, the probability of acute stroke is >85%