ASC Acute Stroke Care & Treatment 1 — Questions and Answers

Question 1: What is the primary goal during the acute phase of stroke treatment?

Schedule rehabilitation services.
Limit patient mobility.
Restore perfusion and prevent further damage. (Correct answer)
Wait for neurological decline.

Correct answer: Restore perfusion and prevent further damage.

During the acute phase of stroke treatment, the primary goal is to rapidly restore blood flow (perfusion) to the brain tissue affected by the stroke and prevent further neurological damage. For ischemic strokes, this often involves administering clot-busting medications like tPA or performing mechanical thrombectomy. Timely intervention is critical to salvage brain tissue and improve patient outcomes.

Question 2: Which drug is most commonly used in ischemic stroke within a specific time window?

Aspirin.
tPA (alteplase). (Correct answer)
Heparin.
Warfarin.

Correct answer: tPA (alteplase).

Tissue plasminogen activator (tPA), specifically alteplase, is the most commonly used thrombolytic drug for acute ischemic stroke. When administered intravenously within a specific time window (typically 3 to 4.5 hours from symptom onset), tPA works by dissolving the blood clot that is blocking blood flow to the brain. This rapid restoration of blood flow can significantly reduce stroke-related disability.

Question 3: What diagnostic imaging is used first in acute stroke evaluation?

MRI with contrast.
Non-contrast CT scan. (Correct answer)
PET scan.
Chest X-ray.

Correct answer: Non-contrast CT scan.

A non-contrast CT scan of the brain is the first and most critical diagnostic imaging performed in acute stroke evaluation. Its primary purpose is to quickly differentiate between an ischemic stroke (caused by a clot) and a hemorrhagic stroke (caused by bleeding). This distinction is crucial because treatment strategies, particularly the use of thrombolytics like tPA, differ drastically and can be harmful if administered in the wrong type of stroke.

Question 4: Which symptom is most commonly associated with acute stroke?

Gradual onset of joint pain.
Sudden unilateral weakness or numbness. (Correct answer)
Chronic fatigue.
Low-grade fever.

Correct answer: Sudden unilateral weakness or numbness.

Sudden unilateral weakness or numbness, affecting one side of the body (face, arm, or leg), is a classic and highly indicative symptom of acute stroke. This occurs due to damage to the brain region controlling motor or sensory functions on the opposite side of the body. Recognizing this sudden onset is crucial for prompt medical attention, as time is critical in stroke treatment.

Question 5: Why is early stroke recognition critical?

To minimize paperwork.
To delay the use of anticoagulants.
To increase patient monitoring time.
To enable timely treatment and reduce brain damage. (Correct answer)

Correct answer: To enable timely treatment and reduce brain damage.

Early stroke recognition is absolutely critical because "time is brain." The sooner a stroke is identified, the sooner medical professionals can initiate appropriate treatments, such as tPA for ischemic strokes or interventions for hemorrhagic strokes. Timely intervention helps restore blood flow, limit the extent of brain damage, and significantly improve the chances of a better recovery and reduced long-term disability.

Question 6: Which scale is commonly used to assess stroke severity?

Glasgow Coma Scale.
Braden Scale.
NIH Stroke Scale (NIHSS). (Correct answer)
Apgar Score.

Correct answer: NIH Stroke Scale (NIHSS).

The NIH Stroke Scale (NIHSS) is a standardized, systematic assessment tool widely used to quantify the severity of neurological deficits caused by a stroke. It evaluates various neurological functions, including consciousness, language, motor strength, sensation, and coordination. The NIHSS score helps guide treatment decisions, predict outcomes, and track changes in a patient's condition over time.

Question 7: What is the recommended time goal for door-to-needle with tPA?

120 minutes.
90 minutes.
60 minutes. (Correct answer)
180 minutes.

Correct answer: 60 minutes.

The recommended time goal for "door-to-needle" with tPA administration in acute ischemic stroke is 60 minutes. This critical benchmark emphasizes the urgency of rapid assessment, diagnosis, and treatment initiation once a patient arrives at the hospital. Achieving this goal ensures that eligible patients receive clot-busting medication as quickly as possible, maximizing the potential for brain tissue salvage and improved neurological outcomes.

Question 8: What should be avoided in acute hemorrhagic stroke care?

Elevating the head of bed.
Giving anticoagulants. (Correct answer)
Providing oxygen therapy.
Monitoring vitals.

Correct answer: Giving anticoagulants.

In acute hemorrhagic stroke, there is active bleeding within the brain. Anticoagulants, such as warfarin or heparin, work by thinning the blood and preventing clot formation. Administering these medications would exacerbate the bleeding, leading to increased brain damage, higher intracranial pressure, and a significantly worse prognosis. Therefore, avoiding anticoagulants is a critical intervention to prevent further harm.

Question 9: Which intervention is part of acute stroke center protocols?

Routine check-in process.
Emergency stroke alert activation. (Correct answer)
Non-urgent laboratory review.
Post-discharge planning only.

Correct answer: Emergency stroke alert activation.

Acute stroke centers are designed for rapid assessment and treatment of stroke patients, where 'time is brain.' Activating an emergency stroke alert immediately mobilizes a specialized multidisciplinary team, including neurologists, emergency physicians, and imaging staff. This streamlined protocol ensures that diagnostic tests and time-sensitive interventions, like thrombolysis or thrombectomy, can be initiated as quickly as possible to minimize brain damage and improve patient outcomes.

ASC Acute Stroke Care & Treatment 1

What is the primary goal during the acute phase of stroke treatment?