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SCRN Study Guide: Hyperacute Care /Questions And Answers
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SCRN Study Guide: Hyperacute Care /QuestionsAnd Answers
Quiz :Communicate effectively with pre-hospital personnel. - √Answer :When
stroke victim activates EMS the time to imaging , neuro exam, ED MD
evaluation is shorter. This should be emphasized in the community. The greatest
time delay is from symptom onset to ED arrival.
EMS alerts the hospital, advance notification by EMS has shown to increase the
use of TpA
Quiz :EMS evaluation primary goals - √Answer :Obtain last seen normal
Obtain blood glucose
Quiz :ABCD score - √Answer :A: age B: blood C: clinical features D: Duration
of TIA symptoms
Quiz :Establish ABC's - √Answer :Airway -Breathing: O2 for SpO2< 94%
Circulation: ECG, BP assessment & IV/Labs (√BG)
D (Neuro): NIHSS or Canadian Neurological Scale (CNS), Neuro Exam &
Neuro MD
Quiz :Posterior stroke - √Answer :There are important differences between
posterior and anterior circulation stroke. The differences include the value of
screening instruments, optimum diagnostic modalities, and clinical features.
The face arm speech test (FAST), a widely used prehospital stroke recognition
screening instrument, is less sensitive for detecting posterior circulation stroke
than for anterior circulation stroke
Quiz :Symptoms of Posterior Circulation Stroke - √Answer :Motor deficits
(weakness, clumsiness, or paralysis of any combination of arms and legs, up to
quadriplegia, sometimes changing from one side to another in different attacks)
"Crossed" syndromes, consisting of ipsilateral cranial nerve dysfunction and
contralateral long motor or sensory tract dysfunction are highly characteristic of
posterior circulation stroke
Sensory deficits (numbness, including loss of sensation or paraesthesia in any
combination of extremities, sometimes including all four limbs or both sides of
the face or mouth)
Homonymous hemianopia—a visual field defect affecting either the two right or
the two left halves of the visual fields of both eyes
, Ataxia, imbalance, unsteadiness, or disequilibrium
Vertigo, with or without nausea and vomiting
Diplopia as a result of ophthalmoplegia
Dysphagia or dysarthria
Isolated reduced level of consciousness is not a typical stroke symptom but can
result from bilateral thalamic or brainstem ischaemia (especially from rostral
basilar artery occlusion)
Quiz :Posterior stroke: Lateral medulla (intracranial vertebral artery infarct, also
known as Wallenberg syndrome) - √Answer :Nystagmus, vertigo, ipsilateral
Horner's syndrome, ipsilateral facial sensory loss, dysarthria, hoarseness, and
dysphagia
Contralateral hemisensory loss in the trunk and limb—pain and temperature
Quiz :posterior stroke: Medial medulla - √Answer :Ipsilateral tongue weakness
and later hemiatrophy of the tongue
Contralateral hemiparesis of the arm and leg
Hemisensory loss—touch and proprioception
Quiz :posterior stroke: Pons - √Answer :Hemiparesis or hemisensory loss,
ataxic hemiparesis, dysarthria, horizontal gaze palsy
Complete infarction causes "locked-in syndrome" with quadriparesis, loss of
speech, but preserved awareness and cognition, and sometimes preserved eye
movements
Quiz :posterior stroke:Top of the basilar (distal basilar occlusion) -
√Answer :Somnolence, confusion (from thalamic infarction)
Bilateral loss of vision, unawareness or denial of blindness (from bilateral
occipital infarction)
Quiz :posterior stroke: Posterior inferior cerebellar artery - √Answer :Truncal
ataxia, vertigo (limb ataxia may occur, especially if the inferior cerebellar
peduncle is affected)
Quiz :posterior stroke: Posterior cerebral artery - √Answer :Contralateral
homonymous hemianopia (from occipital infarction)
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