16 Questions
What happens to the average patient for every minute a large vessel ischemic stroke is left untreated?
All of the above
Why is a 12-lead ECG not necessary at this stage for Adaibaa?
Time is of the essence and a rhythm strip is sufficient
What is the primary reason for maintaining SpO₂ greater than 94% in Adaibaa?
To provide adequate oxygenation
Why should aspirin not be given to Adaibaa at this stage?
The type of stroke has not been confirmed
What is the primary goal of immediate actions in Adaibaa's case?
To minimize brain damage and promote recovery
What is the significance of Adaibaa's blood glucose level taken in the ambulance?
It is within a normal range
What is the primary goal for blood glucose levels in patients with acute stroke?
Maintaining a level between 5 and 15 mmol/L
Why is the NIH Stroke Scale assessment important in stroke patients?
It is a predictor of both short- and long-term outcome of stroke patients
What is the significance of Adaibaa's partial gaze palsy that can be overcome?
It is an aspect of her extraocular movement evaluated by the NIHSS
What is the primary reason for Adaibaa's difficulty in managing her medications?
Her impaired short-term memory
What is the significance of Adaibaa's complete hemianopia?
It is an aspect of her visual-field loss evaluated by the NIHSS
Why is HCG not relevant for this patient?
She is not of child-bearing age
What is the significance of Adaibaa's inability to raise her right arm to 45 degrees?
It is an aspect of her motor strength evaluated by the NIHSS
What is the primary purpose of conducting a cardiac rhythm strip in Adaibaa?
To monitor her heart rate and rhythm
What is the significance of Adaibaa's fragmented language expression?
It is an aspect of her language evaluated by the NIHSS
Why is arterial blood gas not indicated for this patient?
Because it is contraindicated if thrombolysis is given
Study Notes
Stroke Overview
- Stroke occurs when the blood supply to part of the brain is interrupted, affecting mobility, speech, language, cognition, and mood.
- There are two main types of stroke: ischemic (obstruction in a blood vessel) and hemorrhagic (weakened blood vessel rupture).
Importance of Rapid Treatment
- Every minute of untreated large vessel ischemic stroke results in the loss of 1.9 million neurons, 13.8 billion synapses, and 12 km of axonal fibers.
- Each hour without treatment, the brain loses neurons equivalent to 3.6 years of normal aging.
Adaibaa's Case
- Adaibaa, 67, presents with right face, arm, and leg weakness and numbness, unable to speak, with symptoms starting suddenly at 1 pm.
- Blood glucose level is 5.6 mmol/L (100 mg/dL).
- Medical history includes mild cognitive impairment, hypertension, atrial fibrillation, and difficulty managing medications.
Immediate Actions
- Activate stroke alert.
- Maintain SpO₂ > 94%.
- Create IV access.
- Activate transport.
- Keep patient NPO.
- Check vital signs (glucose, blood pressure, heart rate).
- Conduct NIH Stroke Scale assessment.
- Obtain collateral history.
- Obtain cardiac rhythm strip.
- Conduct blood tests.
Examination Results
- Blood pressure: 145/88 mm Hg.
- Heart rate: 110 beats per minute, irregular.
- Temperature: 36.5 ℃.
- O₂ saturation: 99% on room air.
- Respiratory rate: 18 breaths per minute.
- Blood glucose: 5.6 mmol/L (100 mg/dL).
NIH Stroke Scale (NIHSS)
- A bedside assessment tool evaluating acute cerebral infarction's effects on consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.
- Predicts short- and long-term outcomes in stroke patients.
Adaibaa's NIHSS Assessment
- Alert and keenly responsive, but aphasic.
- Partial gaze palsy, which can be overcome.
- Complete hemianopia.
- Partial paralysis of the lower face.
- Able to perform finger-nose-finger test.
- Ataxia in one limb (right leg).
- Duller sense of touch.
- Fragmentary expression with inference needed.
- Slurred speech, but understandable.
Learn about the effects of stroke on brain function and the importance of prompt treatment to prevent neuronal damage.
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