Emergency Medical Services Quiz
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Questions and Answers

What is the primary cause of Large Territorial Infarcts?

  • Embolic sources (correct)
  • Small vessel disease
  • Thrombotic sources
  • Decreased blood flow

    • Which type of infarct is typically caused by emboli formed in the heart?

  • Large Territorial Infarct
  • Watershed Infarct
  • Multiple Small Embolic Infarcts (correct)
  • Lacunar Stroke

    • What characterizes Small Vessel Disease or Lacunar Stroke?

  • Involves small arteries (correct)
  • Occurs during a decrease in blood flow
  • Involves large vessels
  • Usually caused by emboli

    • Watershed strokes are typically a result of which condition?

    <p>Decreased blood flow (B)</p> Signup and view all the answers

    Which infarct type behaves differently from others due to its unique underlying causes?

    <p>Small Vessel Disease/Lacunar Stroke (D)</p> Signup and view all the answers

    What does the NIHSS score range from?

    <p>0 to 42 (D)</p> Signup and view all the answers

    What is a primary purpose of a CT scan in acute stroke evaluation?

    <p>Exclude the presence of bleeds (A)</p> Signup and view all the answers

    Which statement about the NIHSS is NOT true?

    <p>It takes more than 30 minutes to administer (A)</p> Signup and view all the answers

    What type of imaging is recommended for all patients with suspected acute stroke?

    <p>Emergency brain imaging evaluation (A)</p> Signup and view all the answers

    What is the purpose of ambulances equipped with CT scans?

    <p>To identify infarcts or bleeds for immediate treatment decisions (C)</p> Signup and view all the answers

    How quickly can the NIHSS be performed by trained staff?

    <p>10 minutes or less (B)</p> Signup and view all the answers

    Which hospitals are intended for patients exhibiting BEFAST symptoms?

    <p>Acute Stroke Ready Hospitals (ASRH) (C)</p> Signup and view all the answers

    What can be observed immediately on a CT scan compared to an MRI?

    <p>Bleeds (B)</p> Signup and view all the answers

    What scale is used in the emergency room instead of BEFAST?

    <p>ROSIER scale (D)</p> Signup and view all the answers

    What misconception about treating stroke patients is mentioned?

    <p>Patients need to rest before treatment (B)</p> Signup and view all the answers

    What does a higher score on the NIHSS indicate?

    <p>Worsening condition (B)</p> Signup and view all the answers

    What is the significance of the NIHSS in acute stroke assessment?

    <p>It assists in monitoring the improvement or worsening conditions (B)</p> Signup and view all the answers

    What is the function of Acute Stroke Ready Hospitals (ASRH)?

    <p>To provide imaging and laboratory support for stroke diagnosis (C)</p> Signup and view all the answers

    How quickly can some ASRHs treat stroke patients?

    <p>Within 1 hour (A)</p> Signup and view all the answers

    Why is it important not to delay treatment for stroke patients?

    <p>Delays can worsen the patient's condition (D)</p> Signup and view all the answers

    Which of the following statements about first aid for stroke patients is correct?

    <p>No first aid for stroke is effective (C)</p> Signup and view all the answers

    What is the primary purpose of a CT scan in the context of acute stroke evaluation?

    <p>To detect or exclude bleeding (C)</p> Signup and view all the answers

    Which imaging modality is more sensitive and specific for detecting infarcts within the first few hours of a stroke?

    <p>MRI (B)</p> Signup and view all the answers

    What indicates the presence of penumbra in the assessment of stroke using MRI?

    <p>Lesion visible in DWI but not in FLAIR (D)</p> Signup and view all the answers

    When can r-tPA be administered based on imaging findings?

    <p>When DWI shows a lesion and FLAIR does not (A)</p> Signup and view all the answers

    Which of the following sequences is NOT typically used in MRI for acute stroke evaluation?

    <p>X-ray (D)</p> Signup and view all the answers

    What does a lack of mismatch between DWI and FLAIR suggest regarding the administration of tPA?

    <p>tPA administration is contraindicated (C)</p> Signup and view all the answers

    What is the primary information that can be determined from the location of a stroke seen in an MRI?

    <p>The specific vessel involved in the stroke (B)</p> Signup and view all the answers

    What does a reversed diffusion signal in the ADC sequence indicate regarding the age of the stroke?

    <p>The stroke is chronic (C)</p> Signup and view all the answers

    What is the purpose of administering intravenous thrombolysis in acute ischemic stroke?

    <p>To remove the clot from the occluded artery (C)</p> Signup and view all the answers

    What is the recommended administration method for alteplase in acute ischemic stroke patients?

    <p>Infuse 0.9 mg/kg over 60 minutes with a 10% bolus (C)</p> Signup and view all the answers

    Why might the utility of chest radiographs be considered uncertain in acute ischemic stroke treatment?

    <p>They routinely increase the door-to-needle time (B)</p> Signup and view all the answers

    What condition must be monitored in acute ischemic stroke patients after recanalization?

    <p>Worsening or recurrence of stroke symptoms (B)</p> Signup and view all the answers

    What is the primary action taken in the initial treatment of a confirmed acute ischemic stroke?

    <p>Begin intravenous thrombolysis with alteplase (A)</p> Signup and view all the answers

    What is the recommended monitoring setting for patients receiving thrombolysis treatment for acute ischemic stroke?

    <p>Intensive care or stroke unit (D)</p> Signup and view all the answers

    What is a common concern following the recanalization of an occluded artery in stroke patients?

    <p>Possibility of acute hypertension (A)</p> Signup and view all the answers

    What is the maximum cumulative dose of alteplase recommended for acute ischemic stroke treatment?

    <p>90 mg (D)</p> Signup and view all the answers

    Study Notes

    Emergency Medical Service Systems

    • Time-sensitive response is crucial; recommend calling for an ambulance immediately.
    • Acute Stroke Ready Hospitals (ASRH) are designated for BEFAST symptoms treatment.
    • ASRHs include both private and public hospitals capable of rapid intervention.
    • Immediate treatment time for stroke patients varies: SLMC can treat within 1 hour; EAMC may take 1-2 hours.
    • It's essential to identify and know ASRHs in the vicinity, especially for family and friends.

    Stroke Initial Response

    • There is a misconception that stroke patients should rest or take medications like aspirin before reaching a hospital; this is incorrect.
    • The focus is solely on transporting the patient to an ASRH for proper care.
    • Monitoring for condition improvement or deterioration is crucial upon arrival at the hospital.

    National Institute of Health Stroke Scale (NIHSS)

    • NIHSS is a rapid, accurate, and reliable assessment tool with scores from 0 (no symptoms) to 42 (worst score).
    • Designed to evaluate stroke severity, scores depend on patient responses rather than observer interpretations.
    • Imaging evaluation via CT or MRI is necessary for all suspected acute stroke patients before therapy initiation.

    Imaging Techniques

    • The role of CT scans is primarily to exclude intracranial hemorrhages; they are good for identifying bleeds.
    • MRI can detect infarcts more sensitively within the first few hours of stroke onset.
    • CT Angiography assesses vascular causes (e.g., aneurysms) while CT Perfusion evaluates cerebral blood flow metrics.

    CT vs. MRI

    • CT scans solely aim to detect bleeds, while MRI is preferred for identifying infarcts, especially early on.
    • MRI is better for diagnosing posterior circulation strokes and identifying specific vessel involvement.
    • Key MRI sequences include: DWI (Diffusion Weighted Imaging) & ADC (Apparent Diffusion Coefficient), T2, FLAIR, GRE, SWI.

    Neuroimaging Clues to Stroke Etiology

    • Types of infarcts include:
      • Large Territorial Infarct: Associated with embolic sources affecting large vessels.
      • Multiple Small Embolic Infarcts: Result from emboli formed in the heart.
      • Small Vessel Disease/Lacunar Stroke: Caused by thrombotic sources affecting deep brain penetrating arteries.
      • Watershed Infarct: Occurs between major vessel territories due to reduced blood flow.

    Recanalization and Reperfusion

    • Recanalization refers to the reopening of occluded arteries.
    • Initial treatment involves intravenous (IV) thrombolysis with alteplase (r-tPA).
    • Alteplase administration guidelines: infuse 0.9 mg/kg (max 90 mg) over 60 minutes, with a 10% bolus given initially.
    • Post-treatment monitoring in an intensive care unit or stroke unit is essential for potential complications.

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    Description

    Test your knowledge on emergency medical services, specifically regarding the decision-making process in ambulance dispatch and hospital selection for patients. This quiz covers critical procedures such as identifying infarcts or bleeds and using CT scans effectively.

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