INSTRUCTIONS The golden hour Performing an acute ischemic stroke workup
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The golden hour Performing an acute ischemic stroke workup
General Purpose: To provide a summary of recent updates on the rapid evaluation and workup for patient selection and treatment with I.V. fibrinolysis. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Assess patients with symptoms of acute ischemic stroke (AIS) and determine eligibility for the use of I.V. rt-PA. 2. Identify the treatment recommendations for the use of I.V. rt-PA in patients with AIS.
- Ischemic stroke accounts for what percentage of all strokes?
- Cardinal symptoms predictive of stroke include the sudden onset of any of the following except
- facial droop.
- visuospatial neglect.
- slurred speech.
- A hallmark symptom that may result from thrombosis of the basilar artery is the acute onset of
- gait disturbances.
- isolated leg weakness.
- receptive aphasia.
- The time of symptom onset is defined as
- when the patient was last seen normal.
- time of arrival in the ED.
- when the patient was first observed to be symptomatic.
- when the symptoms became severe enough to require an ED visit.
- According to the U.FDA, treatment of AIS with I.rt-PA must begin within (at most) how many hours after symptom onset?
- The NINDS door-to-treatment goal for treating AIS with I.rt-PA is
- ≤30 minutes.
- ≤60 minutes.
- ≤90 minutes.
- ≤120 minutes.
- The NINDS time target for interpretation of the CT scan for patients with suspected AIS is
- ≤15 minutes.
- ≤25 minutes.
- ≤45 minutes.
- ≤60 minutes.
- Which is a contraindication for the treatment of AIS with I.rt-PA within 3 to 4.5 hours?
- age > 80
- gastrointestinal surgery 4 weeks ago
- platelet count 200,000/mm3
- NIHSS score of 20
- Which is not recognized as a condition that mimics stroke?
- systemic infection
- One “essential, immediate” diagnostic test needed before treatment with I.rt-PA is
- an ECG.
- a complete blood cell count.
- cardiac enzymes.
- an oxygen saturation.
- For a patient who is not on anticoagulants and has no known bleeding diatheses, the only lab test that must be obtained before I.rt-PA administration is
- blood glucose.
- Which statement about use of I.rt-PA for patients on the newer anticoagulants such as dabigatran is true?
- The risk of using I.rt-PA for the treatment of AIS in any patient on dabigatran outweighs the potential benefits.
- An INR will accurately reflect of the degree of anticoagulation.
- I.rt-PA is contraindicated in any patient on anticoagulants.
- I.rt-PA may be used in eligible patients who have not received the medication for at least 2 days.
- Which test is used routinely for emergent brain imaging in AIS?
- contrast CT
- noncontrast CT
- magnetic resonance angiography
- Treatment with I.rt-PA should be avoided if the imaging study results reveal frank hypodensity involving > 1/3 of the
- basilar artery territory.
- posterior cerebral artery territory.
- MCA territory.
- anterior inferior cerebellar artery territory.
- During the golden hour, patients eligible for rt-PA must have their BP lowered when systolic and diastolic pressures rise above
- 155 mm Hg or 80 mm Hg, respectively.
- 165 mm Hg or 90 mm Hg, respectively.
- 175 mm Hg or 100 mm Hg, respectively.
- 185 mm Hg or 110 mm Hg, respectively.
- Which statement is true about managing BP in patients eligible for rt-PA treatment?
- It is reasonable to abstain from I.rt-PA therapy when the BP is resistant to treatment.
- The BP should be maintained ≤160/90 mm Hg for at least 12 hours post rt-PA treatment.
- Metoprolol is recommended for lowering BP during the hyperacute period of AIS.
- Rapidly lowering the systemic BP can have a dramatic, beneficial effect on cerebral ischemia.
- The dose for I.rt-PA in the treatment of AIS is
- 0.6 mg/kg.
- 0.9 mg/kg.
- 1.2 mg/kg.
- 1.5 mg/kg.
- The maximum dose of rt-PA for patients with AIS is
- 50 mg.
- 65 mg.
- 90 mg.
- 100 mg.