Podcast
Questions and Answers
What is the primary cause of Large Territorial Infarcts?
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?
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?
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?
Watershed strokes are typically a result of which condition?
Which infarct type behaves differently from others due to its unique underlying causes?
Which infarct type behaves differently from others due to its unique underlying causes?
What does the NIHSS score range from?
What does the NIHSS score range from?
What is a primary purpose of a CT scan in acute stroke evaluation?
What is a primary purpose of a CT scan in acute stroke evaluation?
Which statement about the NIHSS is NOT true?
Which statement about the NIHSS is NOT true?
What type of imaging is recommended for all patients with suspected acute stroke?
What type of imaging is recommended for all patients with suspected acute stroke?
What is the purpose of ambulances equipped with CT scans?
What is the purpose of ambulances equipped with CT scans?
How quickly can the NIHSS be performed by trained staff?
How quickly can the NIHSS be performed by trained staff?
Which hospitals are intended for patients exhibiting BEFAST symptoms?
Which hospitals are intended for patients exhibiting BEFAST symptoms?
What can be observed immediately on a CT scan compared to an MRI?
What can be observed immediately on a CT scan compared to an MRI?
What scale is used in the emergency room instead of BEFAST?
What scale is used in the emergency room instead of BEFAST?
What misconception about treating stroke patients is mentioned?
What misconception about treating stroke patients is mentioned?
What does a higher score on the NIHSS indicate?
What does a higher score on the NIHSS indicate?
What is the significance of the NIHSS in acute stroke assessment?
What is the significance of the NIHSS in acute stroke assessment?
What is the function of Acute Stroke Ready Hospitals (ASRH)?
What is the function of Acute Stroke Ready Hospitals (ASRH)?
How quickly can some ASRHs treat stroke patients?
How quickly can some ASRHs treat stroke patients?
Why is it important not to delay treatment for stroke patients?
Why is it important not to delay treatment for stroke patients?
Which of the following statements about first aid for stroke patients is correct?
Which of the following statements about first aid for stroke patients is correct?
What is the primary purpose of a CT scan in the context of acute stroke evaluation?
What is the primary purpose of a CT scan in the context of acute stroke evaluation?
Which imaging modality is more sensitive and specific for detecting infarcts within the first few hours of a stroke?
Which imaging modality is more sensitive and specific for detecting infarcts within the first few hours of a stroke?
What indicates the presence of penumbra in the assessment of stroke using MRI?
What indicates the presence of penumbra in the assessment of stroke using MRI?
When can r-tPA be administered based on imaging findings?
When can r-tPA be administered based on imaging findings?
Which of the following sequences is NOT typically used in MRI for acute stroke evaluation?
Which of the following sequences is NOT typically used in MRI for acute stroke evaluation?
What does a lack of mismatch between DWI and FLAIR suggest regarding the administration of tPA?
What does a lack of mismatch between DWI and FLAIR suggest regarding the administration of tPA?
What is the primary information that can be determined from the location of a stroke seen in an MRI?
What is the primary information that can be determined from the location of a stroke seen in an MRI?
What does a reversed diffusion signal in the ADC sequence indicate regarding the age of the stroke?
What does a reversed diffusion signal in the ADC sequence indicate regarding the age of the stroke?
What is the purpose of administering intravenous thrombolysis in acute ischemic stroke?
What is the purpose of administering intravenous thrombolysis in acute ischemic stroke?
What is the recommended administration method for alteplase in acute ischemic stroke patients?
What is the recommended administration method for alteplase in acute ischemic stroke patients?
Why might the utility of chest radiographs be considered uncertain in acute ischemic stroke treatment?
Why might the utility of chest radiographs be considered uncertain in acute ischemic stroke treatment?
What condition must be monitored in acute ischemic stroke patients after recanalization?
What condition must be monitored in acute ischemic stroke patients after recanalization?
What is the primary action taken in the initial treatment of a confirmed acute ischemic stroke?
What is the primary action taken in the initial treatment of a confirmed acute ischemic stroke?
What is the recommended monitoring setting for patients receiving thrombolysis treatment for acute ischemic stroke?
What is the recommended monitoring setting for patients receiving thrombolysis treatment for acute ischemic stroke?
What is a common concern following the recanalization of an occluded artery in stroke patients?
What is a common concern following the recanalization of an occluded artery in stroke patients?
What is the maximum cumulative dose of alteplase recommended for acute ischemic stroke treatment?
What is the maximum cumulative dose of alteplase recommended for acute ischemic stroke treatment?
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.
