Emergency Medical Services Quiz

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?

Decreased blood flow Signup and view all the answers

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

Small Vessel Disease/Lacunar Stroke Signup and view all the answers

What does the NIHSS score range from?

0 to 42 Signup and view all the answers

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

Exclude the presence of bleeds Signup and view all the answers

Which statement about the NIHSS is NOT true?

It takes more than 30 minutes to administer Signup and view all the answers

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

Emergency brain imaging evaluation Signup and view all the answers

What is the purpose of ambulances equipped with CT scans?

To identify infarcts or bleeds for immediate treatment decisions Signup and view all the answers

How quickly can the NIHSS be performed by trained staff?

10 minutes or less Signup and view all the answers

Which hospitals are intended for patients exhibiting BEFAST symptoms?

Acute Stroke Ready Hospitals (ASRH) Signup and view all the answers

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

Bleeds Signup and view all the answers

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

ROSIER scale Signup and view all the answers

What misconception about treating stroke patients is mentioned?

Patients need to rest before treatment Signup and view all the answers

What does a higher score on the NIHSS indicate?

Worsening condition Signup and view all the answers

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

It assists in monitoring the improvement or worsening conditions Signup and view all the answers

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

To provide imaging and laboratory support for stroke diagnosis Signup and view all the answers

How quickly can some ASRHs treat stroke patients?

Within 1 hour Signup and view all the answers

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

Delays can worsen the patient's condition Signup and view all the answers

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

No first aid for stroke is effective Signup and view all the answers

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

To detect or exclude bleeding 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?

MRI Signup and view all the answers

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

Lesion visible in DWI but not in FLAIR Signup and view all the answers

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

When DWI shows a lesion and FLAIR does not Signup and view all the answers

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

X-ray Signup and view all the answers

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

tPA administration is contraindicated 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?

The specific vessel involved in the stroke Signup and view all the answers

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

The stroke is chronic Signup and view all the answers

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

To remove the clot from the occluded artery Signup and view all the answers

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

Infuse 0.9 mg/kg over 60 minutes with a 10% bolus Signup and view all the answers

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

They routinely increase the door-to-needle time Signup and view all the answers

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

Worsening or recurrence of stroke symptoms Signup and view all the answers

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

Begin intravenous thrombolysis with alteplase Signup and view all the answers

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

Intensive care or stroke unit Signup and view all the answers

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

Possibility of acute hypertension Signup and view all the answers

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

90 mg 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.