Know Your Guidelines – Early Management of Acute Ischemic Stroke

Andrea Eberly, MD, MS, FAAEMEmergency Medicine, Guideline Knowledge Check, Medical News

Check your knowledge of acute ischemic stroke guidelines

Clinical Guideline Knowledge Check:
Early Management of Acute Ischemic Stroke

The 2018 AHA Ischemic Stroke Guidelines contain more recommendations than ever regarding brain imaging and initial medical/invasive treatment choices.

Try the review question below and find out how these guidelines affect ischemic stroke care.  Learn what’s recently changed and what has not changed regarding early treatment of acute ischemic stroke.

Stay in step with current national guidelines with Med-Challenger Guideline Knowledge Checks.

Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.

Test your knowledge of the most current Acute Ischemic Stroke Guidelines…

Case Question:

A 76-year-old, previously healthy woman presents to the hospital with a new onset gaze palsy, difficulty with speech, unilateral weakness / numbness, somnolence, and confusion.

These symptoms began suddenly about 30 minutes ago while she was giving a talk at a senior citizens meeting.

Her initial National Institute of Health Stroke Scale (NIHSS) score is determined to be 14.

What do the 2018 AHA guidelines recommend with regards to initial imaging and treatment of the above patient?

Answer Options:

If her initial brain imaging exhibits extensive regions of hypoattenuation, do not administer intravenous thrombolysis; proceed directly to endovascular thrombectomy.

As long as time to intravenous thrombolysis is not delayed, perform a CT angiogram instead of a non-contrast CT scan as her first imaging study.

Initiating brain imaging within 30 minutes of arrival at the emergency department is a newly added time-sensitive system goal.

If a non-contrast head CT shows no hemorrhage: based on her high pre-stoke level of function in combination with a high NIHSS score, she should undergo immediate endovascular clot removal rather than intravenous thrombolysis.

Answer Explanation & References:


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With each update of national clinical practice guidelines, some recommendations change and many remain unchanged. Med-Challenger Guideline Knowledge Checks help you know both what is new and what has stayed the same in the most recent guidelines pertinent to each medical specialty.

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About the Author:

Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.