ACLS - Advanced Cardiovascular Life Support Acute Stroke Care Questions and Answers — Questions and Answers
Question 1: A 67-year-old male arrives at the Emergency Department with signs of an acute stroke that began 90 minutes ago. After an initial assessment, which of the following actions is the highest priority according to the ACLS Stroke Algorithm?
- Administer 325 mg of aspirin.
- Obtain a non-contrast head CT scan. (Correct answer)
- Consult with the neurology service.
- Draw blood for a complete blood count and coagulation studies.
Correct answer: Obtain a non-contrast head CT scan.
The most critical initial step in the in-hospital management of a potential stroke patient is to obtain a non-contrast head CT scan. This is essential to differentiate between an ischemic and a hemorrhagic stroke, as the treatments are vastly different and administering fibrinolytics in the case of a hemorrhage is life-threatening. While other actions are important, they follow the CT scan results.
Question 2: According to the American Heart Association's time-sensitive goals for acute stroke care, what is the target 'door-to-needle' time for the administration of intravenous alteplase in eligible candidates?
- Within 30 minutes of arrival.
- Within 90 minutes of arrival.
- Within 60 minutes of arrival. (Correct answer)
- Within 45 minutes of arrival.
Correct answer: Within 60 minutes of arrival.
The established 'door-to-needle' goal for administering intravenous alteplase to eligible patients with acute ischemic stroke is within 60 minutes of their arrival at the hospital. This benchmark emphasizes the need for rapid evaluation, imaging, and decision-making to maximize the potential for a good outcome.
Question 3: A 72-year-old female presents with symptoms of an acute ischemic stroke that started 2 hours ago. A non-contrast head CT confirms no hemorrhage. However, her blood pressure on repeated measurements is 190/112 mmHg. What is the most appropriate next step before administering fibrinolytic therapy?
- Administer alteplase immediately as she is within the time window.
- Give a full dose of aspirin and monitor blood pressure.
- Withhold alteplase as hypertension is an absolute contraindication.
- Carefully lower her blood pressure to be at or below 185/110 mmHg. (Correct answer)
Correct answer: Carefully lower her blood pressure to be at or below 185/110 mmHg.
For a patient to be eligible for intravenous alteplase, their blood pressure must be at or below 185/110 mmHg. If the blood pressure is higher, it must be carefully lowered and stabilized before alteplase administration to reduce the risk of hemorrhagic conversion.
Question 4: Which of the following is a core component of the Cincinnati Prehospital Stroke Scale (CPSS) used for rapid stroke assessment?
- Facial droop (Correct answer)
- Pupil reaction
- Grip strength
- Blood glucose level
Correct answer: Facial droop
The Cincinnati Prehospital Stroke Scale (CPSS) is a simple, three-part assessment to identify potential stroke patients. The three components are Facial Droop, Arm Drift, and Abnormal Speech. An abnormality in any one of these three areas indicates a high probability of a stroke.
Question 5: The '8 D's of Stroke Care' outline the ideal chain of survival. Which 'D' specifically refers to the rapid triage, evaluation, and management of the patient within the emergency department?
- Delivery
- Decision
- Data (Correct answer)
- Dispatch
Correct answer: Data
In the '8 D's of Stroke Care', 'Data' refers to the rapid collection of information within the emergency department, including triage, patient evaluation, and management, which includes the crucial non-contrast head CT. 'Dispatch' is the activation of EMS, 'Delivery' is the transport to the hospital, and 'Decision' is the selection of therapy.
Question 6: A patient with a confirmed acute ischemic stroke is a candidate for alteplase. Which of the following is an absolute contraindication for administering this fibrinolytic therapy?
- Patient age over 80 years.
- History of a well-controlled diabetic condition.
- Evidence of active internal bleeding. (Correct answer)
- Stroke symptoms are considered severe (NIHSS > 22).
Correct answer: Evidence of active internal bleeding.
Active internal bleeding is an absolute contraindication to the administration of alteplase due to the high risk of exacerbating the hemorrhage. While advanced age and stroke severity are factors to consider, they are not absolute contraindications. A history of diabetes is also not a contraindication.
ACLS - Advanced Cardiovascular Life Support Acute Stroke Care Questions and Answers
A 67-year-old male arrives at the Emergency Department with signs of an acute stroke that began 90 minutes ago.
After an initial assessment, which of the following actions is the highest priority according to the ACLS Stroke Algorithm?