Telestroke & Remote Care Flashcards
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Read the first 7 Telestroke & Remote Care flashcards as text
A spoke hospital initiates a telestroke consult. The neurologist cannot visualize the patient adequately due to poor camera angle. What is the BEST immediate action by the bedside nurse?
Answer: Reposition the camera to focus on the patient's face and affected limbs
Repositioning the camera ensures the remote neurologist can perform an adequate visual neurological assessment.
Which metric is most commonly used to evaluate the clinical effectiveness of a telestroke program?
Answer: Door-to-needle time for IV tPA at spoke hospitals
Door-to-needle time is the primary quality metric because it directly reflects timely thrombolytic treatment delivery.
A patient presents to a rural ED with last known well time of 3 hours. The telestroke neurologist recommends IV tPA. The local ED physician is hesitant due to uncontrolled hypertension of 195/105. What should the stroke coordinator advise?
Answer: Lower blood pressure to below 185/110 before tPA administration per AHA guidelines
AHA/ASA guidelines require blood pressure to be below 185/110 mmHg before IV tPA administration in eligible patients.
What is the primary advantage of a 'drip-and-ship' telestroke model compared to 'drip-and-stay'?
Answer: Patient receives tPA locally then transfers for higher-level care if needed
Drip-and-ship allows timely tPA administration at the spoke site followed by transfer to a comprehensive stroke center for advanced interventions.
During a telestroke call, the spoke site's internet connection drops mid-consult. What is the recommended backup communication protocol?
Answer: Switch to telephone consultation using a pre-established protocol
Pre-established telephone backup protocols ensure continuity of care when video connectivity fails during acute telestroke consults.
Which imaging modality, when available via telestroke review, is MOST useful for identifying large vessel occlusion (LVO) candidates for mechanical thrombectomy?
Answer: CT Angiography (CTA)
CT Angiography identifies proximal arterial occlusions that determine candidacy for mechanical thrombectomy.
A telestroke neurologist diagnoses hemorrhagic stroke on CT review. The remote ED team asks about next steps. What is the most critical immediate intervention recommendation?
Answer: Control blood pressure, reverse anticoagulation if applicable, and arrange urgent neurosurgical consultation
For hemorrhagic stroke, blood pressure management, reversal of coagulopathy, and neurosurgical consultation are immediate priorities; tPA is contraindicated.