Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her...
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Transcript of Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her...
![Page 1: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/1.jpg)
Stroke Case Studies
![Page 2: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/2.jpg)
Case Study 1 • 72 yo female collapses at home while eating
dinner with her daughter. EMS brings the patient to your ER and you note the following: garbled speech, right sided hemiplegia, able to briskly follow commands with left side, and able to write answers to questions. Vitals: BP 177/90, P 88 bpm and irregular, RR 18, O2 95% on room air
![Page 3: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/3.jpg)
What is your FIRST action?
A. Administer IV tPaB. Give 10 mg IV
LabetalolC. Obtain STAT head
CTD. Obtain STAT brain
MRI
![Page 4: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/4.jpg)
Which artery is likely affected?
A. Right Middle Cerebral Artery (MCA)
B. Left Middle Cerebral Artery (MCA)
C. Right Anterior Cerebral Artery (ACA)
D. Left Anterior Cerebral Artery (ACA)
![Page 5: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/5.jpg)
What is the name of the patient’s language disorder?
A.Adam’s AphasiaB.Wernicke’s (receptive) aphasiaC.Broca’s (expressive) AphasiaD.Global Aphasia
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Case Study 2Mrs. Liken is a 48 yo female who presents to the ED with “the worst headache of her life”. She states the pain is the worst in the back of her head and her neck. Past medical hx: HTN (noncompliant) and tobacco use. Vitals: 174/88, 103, 99% on room air, RR 22
![Page 7: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/7.jpg)
What is your #1 differential diagnosis?
A. Intracerebral Hemorrhage
B. Subdural HematomaC. Epidural HematomaD. Subarachnoid
Hemorrhage
![Page 8: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/8.jpg)
Case Study 2
![Page 9: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/9.jpg)
Given the confirmed diagnosis of SAH, what is considered the gold standard for diagnosing an aneurysmal SAH?
A. MRIB. MRVC. AngiogramD. CTA
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While awaiting intervention (coiling or clipping), what is the number one priority ?
A. Make the patient NPO for the procedure
B. Assure adequate hydration given the large contrast load
C. Obtain echocardiogram to assess for myocardial stunning
D. Strict blood pressure control to prevent re-rupture of the aneurysm
![Page 11: Stroke Case Studies. Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note.](https://reader036.fdocuments.in/reader036/viewer/2022082211/5697c01f1a28abf838cd1a8c/html5/thumbnails/11.jpg)
Case Study 3EMS brings a 59 yo homeless male to your Emergency Department. No known past medical history is known. EMS was called when the patient was found in a park on the ground shaking his left arm and leg. Positive loss of consciousness was briefly noted.
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Case Study 3The patient regains consciousness in the ambulance but is substantially weaker on his left side. He states this is new. EMS initiates CODE STROKE per protocol. CT of head is negative for hemorrhage and the patient is unable to receive an MRI 2/2 bullet fragments.
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Should you consider the patient for IV tPa?
A. YesB. No