ASC Telestroke & Remote Care 2 — Questions and Answers
Question 1: 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?
- End the call and retry later
- Reposition the camera to focus on the patient's face and affected limbs (Correct answer)
- Describe findings verbally and skip the video
- Transfer the patient immediately without completing the consult
Correct 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.
Question 2: Which metric is most commonly used to evaluate the clinical effectiveness of a telestroke program?
- Number of telestroke consults per month
- Door-to-needle time for IV tPA at spoke hospitals (Correct answer)
- Cost per consultation
- Number of patient transfers to the hub
Correct 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.
Question 3: 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?
- Administer tPA immediately without addressing blood pressure
- Withhold tPA permanently since the patient is hypertensive
- Lower blood pressure to below 185/110 before tPA administration per AHA guidelines (Correct answer)
- Transfer without treatment since the time window has passed
Correct 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.
Question 4: What is the primary advantage of a 'drip-and-ship' telestroke model compared to 'drip-and-stay'?
- Lower cost of treatment
- Patient receives tPA locally then transfers for higher-level care if needed (Correct answer)
- Patient stays at the spoke hospital for all care
- Avoids the need for neurologist involvement
Correct 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.
Question 5: During a telestroke call, the spoke site's internet connection drops mid-consult. What is the recommended backup communication protocol?
- Reschedule the consult for the next day
- Switch to telephone consultation using a pre-established protocol (Correct answer)
- Wait for the connection to restore before proceeding
- Discharge the patient and follow up outpatient
Correct 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.
Question 6: Which imaging modality, when available via telestroke review, is MOST useful for identifying large vessel occlusion (LVO) candidates for mechanical thrombectomy?
- Plain skull X-ray
- CT Angiography (CTA) (Correct answer)
- MRI FLAIR sequence
- Chest CT
Correct answer: CT Angiography (CTA)
CT Angiography identifies proximal arterial occlusions that determine candidacy for mechanical thrombectomy.
Question 7: 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?
- Administer IV tPA immediately
- Control blood pressure, reverse anticoagulation if applicable, and arrange urgent neurosurgical consultation (Correct answer)
- Administer aspirin 325mg
- Observe for 24 hours before further action
Correct 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.
ASC Telestroke & Remote Care 2
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?