CVA

Question 1

What are some conditions that may mimic a stroke?

Answer 1

• Drug ingestion (e.g., cocaine)
• Hypoglycemia
• Severe hypertension, hypertensive emergency
• Central nervous system (CNS) infection (e.g., meningitis)

These conditions can present symptoms similar to those of a stroke.

Question 2

During a secondary survey, what should be assessed in the head/neck?

Answer 2

• Facial symmetry
• Pupillary size, equality, and reactivity
• Abnormal speech
• Presence of stiff neck

These assessments help identify neurological deficits.

Question 3

What should be assessed in the central nervous system during a secondary survey?

Answer 3

• Abnormal motor function (e.g., hand grip strength, arm/leg movement/drift)
• Sensory loss

These assessments are crucial for evaluating the patient’s neurological status.

Question 4

What is important to ensure during patient movement?

Answer 4

• Adequate support for the patient’s body/limbs
• Extra padding and support beneath affected limbs

This helps prevent further injury and provides comfort.

Question 5

What potential problems should be prepared for in a patient who may have had a stroke?

Answer 5

• Possible airway obstruction (if loss of tongue control, gag reflex)
• Decreasing level of consciousness
• Seizures
• Agitation, confusion, or combativeness

Being prepared for these issues is critical in emergency care.

Question 6

What are some conditions that may mimic a stroke?

Answer 6

• Drug ingestion (e.g., cocaine)
• Hypoglycemia
• Severe hypertension, hypertensive emergency
• Central nervous system (CNS) infection (e.g., meningitis)

These conditions can present symptoms similar to those of a stroke.

Question 7

During a secondary survey, what should be assessed in the head/neck?

Answer 7

• Facial symmetry
• Pupillary size, equality, and reactivity
• Abnormal speech
• Presence of stiff neck

These assessments help identify neurological deficits.

Question 8

What should be assessed in the central nervous system during a secondary survey?

Answer 8

• Abnormal motor function (e.g., hand grip strength, arm/leg movement/drift)
• Sensory loss

These assessments are crucial for evaluating the patient’s neurological status.

Question 9

What is important to ensure during patient movement?

Answer 9

• Adequate support for the patient’s body/limbs
• Extra padding and support beneath affected limbs

This helps prevent further injury and provides comfort.

Question 10

What potential problems should be prepared for in a patient who may have had a stroke?

Answer 10

• Possible airway obstruction (if loss of tongue control, gag reflex)
• Decreasing level of consciousness
• Seizures
• Agitation, confusion, or combativeness

Being prepared for these issues is critical in emergency care.

Question 11

What should be done if a patient is apneic or has inadequate respirations?

Answer 11

• Ventilate the patient
• Monitor ETCO2 values of 35-45 mmHg

If signs of cerebral herniation are present, hyperventilate to maintain ETCO2 values of 30-35 mmHg.

Question 12

What are the signs of cerebral herniation?

Answer 12

• Deteriorating GCS <9
• Dilated and unreactive pupils
• Asymmetric pupillary response
• Unilateral or bilateral decorticate or decerebrate posturing

These signs indicate increased intracranial pressure and require immediate intervention.

Question 13

If ETCO monitoring is unavailable and signs of cerebral herniation are present, how should you hyperventilate the patient?

Answer 13

• Adult: approximately 20 breaths per minute
• Child: approximately 25 breaths per minute
• Infant <1 year old: approximately 30 breaths per minute

This approach is necessary to manage increased intracranial pressure.

Question 14

What scale is used to perform a secondary screen for LVO stroke?

Answer 14

Los Angeles Motor Scale (LAMS)

This scale is used for all probable stroke patients presenting within 24 hours of symptom onset.

Question 15

If LAMS is greater than or equal to 4, how should the patient be classified?

Answer 15

CTAS 2

This classification indicates a high priority for medical attention.

Question 16

What should be documented for patients presenting with CVA/Stroke symptoms within 24 hours?

Answer 16

LAMS screen results

Documentation is essential for informing the receiving hospital about the patient’s condition.

Question 17

True or false: You should ventilate a patient with inadequate respirations only if ETCO monitoring is available.

Answer 17

FALSE

Ventilation should be performed regardless of ETCO monitoring if the patient is apneic or has inadequate respirations.

Question 18

What is the first step in the Acute Stroke Bypass Protocol?

Answer 18

Assess the patient for symptoms consistent with acute stroke

Symptoms include inappropriate words or mute, slurred speech, unilateral arm weakness or drift, unilateral facial droop, or unilateral leg weakness or drift.

Question 19

List the symptoms to assess for in the Acute Stroke Bypass Protocol.

Answer 19

• Inappropriate words or mute
• Slurred speech
• Unilateral arm weakness or drift
• Unilateral facial droop
• Unilateral leg weakness or drift

These symptoms help determine if the patient may be experiencing an acute stroke.

Question 20

What must be determined after assessing the patient for symptoms in the Acute Stroke Bypass Protocol?

Answer 20

If the patient can be transported to a Designated Stroke Centre within 6 hours of symptom onset

This is crucial for effective treatment of stroke.

Question 21

True or false: Patients presenting within 6 hours of stroke symptom onset may be redirected to the closest EVT centre if they meet certain criteria.

Answer 21

TRUE

In select regions, LVO Clinical Screen + patients may be redirected to an EVT centre.

Question 22

What are the contraindications for patient assessment listed in paragraph 3?

Answer 22

• CTAS 1 and/or uncorrected airway, breathing or circulation issue
• Stroke symptoms resolved prior to paramedic arrival or assessment
• Blood Glucose Level <3 mmol/L
• Seizure at the onset of symptoms or observed by the paramedic
• Glasgow Coma Scale <10
• Terminally ill or in palliative care
• Duration of transport to the Designated Stroke Centre will exceed two hours

These criteria must be assessed before proceeding with patient care.

Question 23

If a patient does not meet any contraindications, what should be performed next?

Answer 23

A secondary screen for a Large Vessel Occlusion (LVO) stroke using the Los Angeles Motor Scale (LAMS)

Inform the CACC/ACS of the LAMS score to assist in determining the closest or most appropriate Designated Stroke Centre.

Question 24

True or false: If a patient’s symptoms improve during transport to a Designated Stroke Centre, you should stop transport.

Answer 24

FALSE

Continue transport to the Designated Stroke Centre even if symptoms improve significantly.

Question 25

What does a **Designated Stroke Centre** include?

Answer 25

* Regional Stroke Centre * District Stroke Centre * Telestroke Centre ## Footnote This designation applies regardless of EVT capability.

Question 26

Fill in the blank: A **blood glucose level** of _______ is considered a contraindication.

Answer 26

<3 mmol/L ## Footnote This level indicates a potential issue that must be addressed before further assessment.

Question 27

What is the **Glasgow Coma Scale** score that indicates a contraindication?

Answer 27

<10 ## Footnote A score below 10 suggests significant impairment in consciousness.