tPA
Within this amount of time from Last Known Well (LKW), patients are eligible for tPA?
What is under 4.5 hours?
The acronym BEFAST stands for these common stroke symptoms
What is Balance, Eye Movement, Face (Facial Droop), Arm, Speech, and Time?
Patient has NIHSS 9. He presents with:
- adequate alertness and is able to to follow commands (LOC 1a and c =0), but cannot respond to questions (LOC 1b =2)
- a left gaze preference (2-Best Gaze =1)
- intact visual fields (3- visual fields = 0)
- notable R facial paresis (facial paresis =2)
- drift in RUE and RLE, but not L (5 R arm = 4, 6 L arm =0, 7 R leg = 2, 8 L leg =0)
- no ataxia (9-limb ataxia =0)
- sensation is normal (10-Sensory = 0)
-inability to name, repeat, or read (11-Best Language =2)
- mild dysarthria (12- Dysarthria=1)
- no neglect (13-Neglect/Inattention = 0)
What is L MCA?
This symptom is most commonly seen in patients with subarachnoid hemorrhage
What is a thunderclap headache? (WHOL)
This is an example of a common stroke mimic
What is hypoglycemia? or any of the following: migraine, Bell's Palsy, seizure, sepsis, brain tumor?
This is the "door-to-needle" national standard (in minutes) for treatment in patients with acute ischemic stroke eligible for IV-tPA
What is 45 minutes?
This must be completed before a stroke or suspected stroke patient is given anything by mouth. Reminder: Meds too!
What is the 3 oz Swallow Screen?
Patient has NIHSS 25. He presents with:
- drowsy (LOC 1a= 1), unable to answer questions, but follows commands for blinking (LOC 1b = 2, LOC 1c =1)
- disconjugate gaze, with only vertical eye movements intact (2-Best Gaze =2)
- normal visual fields (3- visual fields = 0)
- no facial movement (4-facial paresis =3)
- no antigravity in any limb (5-8 Motor =3 for each R limb)
- unable to test ataxia (9-limb ataxia =0)
- no sensory loss (10-Sensory = 0)
- nonverbal (11-Best Language =2-3)
- anarthric scored as severe (12- Dysarthria=2-3)
- no neglect (13-Neglect/Inattention = 0)
What is a basilar occlusion?
This is the most common cause of spontaneous ICH in adults
What is hypertension?
Specific medication question to ask early in triaging patients with concern for stroke.
What is asking specifically about anticoagulants?
This is the appropriate action when your patient receiving TPA develops nausea, vomiting and a decreased LOC.
What is stopping TPA?
This assessment is often used to determine if a thrombectomy is viable when Last Known Well is unable to be determined.
What is a CT Perfusion?
Patient has NIHSS 18. He presents with:
- drowsy (LOC 1a = 1, b and c =0), but oriented and able to to follow commands.
- a right gaze deviation (2-Best Gaze =2)
- a left visual field deficit (3- visual fields = 2)
- minor L facial paresis (facial paresis =1)
- hemiplegia in L RUE and RLE, but not R (5, 7-R arm + R leg=0, and 6, 8 - L arm + leg =3)
- no ataxia (9-limb ataxia =0)
- mild sensory loss on L side (10-Sensory = 1)
- No aphasia (11-Best Language =0)
- mild dysarthria (12- Dysarthria=1)
- complete neglect of L side (13-Neglect/Inattention = 2)
What is the right MCA?
This score is used to predict 30-day mortality in hemorrhagic stroke
What is ICH score?
Delay in this action often result in delayed administration of medication, such as nimodipine, that should be administered within 24 hours of arrival.
What is NGT placement?
This complication of tPA can affect the airway and may result in intubation
What is angioedema?
This score is used to predict 30-day mortality in hemorrhagic stroke
What is the ICH score?
Patient has NIHSS 9. He presents with:
- adequate alertness (LOC 1a, b, and c =0) and able to to follow commands.
-a left gaze (2-Best Gaze =1)
- a right visual field cut (3- visual fields = 2)
- minor R facial paresis (facial paresis =1)
- drift in RUE and RLE, but not L (5-8 Motor =1 for each R limb)
- no ataxia (9-limb ataxia =0)
- mild sensory loss on R side (10-Sensory = 1)
- speech has reduced fluency and naming. He can write, but not read (11-Best Language =1)
- mild dysarthria (12- Dysarthria=1)
- no neglect (13-Neglect/Inattention = 0)
What is L PCA?
These symptoms are more commonly seen in ICH compared to ischemic strokes
What is:
For stroke recovery, this early intervention is recommended for improvement of deficits and prevention of long term disability.
What is early mobility?
These are BP parameters to administer TPA.
What is less than 185/110 mmHg? (remember after TPA goal is <180/105 mmHg)
Eye opening, verbal response, and motor response, make up components of this assessment of consciousness.
What is the Glasgow Coma Scale?
Patient comes in and she has no score on NIHSS; however, her voice is a bit hoarse and when performing the swallow screen she FAILS and notes she can't get anything down. Assuming she did have a stroke, this vessel is likely the one to be occluded.
What is the posterior inferior cerebellar artery (PICA)?
This is the percentage of patients with aneurysmal SAH and unprotected aneurysm that experience re-bleed 2 weeks after initial bleed
What is 25%?
Before discharge, patients should be educated on these five factors:
What is
1. Activation of emergency medical system
2. Follow-up after discharge
3. Medications prescribed at discharge
4. Risk factors for stroke
5. Warning signs and symptoms of stroke