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*It is only for medical professionals to read for reference.
How to make a decision in these situations? The American Stroke Association (ASA) will teach you how to do the questions online, with the latest guide analysis~ Come and watch! Case: A 180-year-old female patient with well-functioning body suffered a sudden stroke at 5 o'clock in the afternoon of the day, causing weakness in the right limb and speech difficulties.
Two months ago, the patient felt weakness in his left arm and leg, but no other neurological symptoms.
He did not seek medical treatment, and his symptoms gradually eased after 4 weeks.
When the patient arrived at the hospital at 7 o'clock in the evening, the patient was already completely aphasia, left eye eccentric vision, right hemiplegia and decreased feeling.
He has a history of hypertension, the National Institutes of Health Stroke Scale (NIHSS) score is 24, blood pressure is 160/100mmHg, and blood sugar is 82mg/dL.
In indoor air, blood oxygen saturation is 99%, body temperature is 37 degrees Celsius, electrocardiogram (KEG) shows normal sinus rhythm, CT scan results show that the patient’s Alberta stroke plan early diagnosis score (ASPECTS) score is 10 The angiography (CTA) showed that the patient’s proximal middle cerebral artery (M1) was blocked.
CT perfusion imaging (CTP) was performed at 7:30 in the evening.
The results showed that the infarct volume with a peak time (Tmax)> 6 seconds was 45 mL, and the infarct volume with a blood flow (CBF) <30% was 30 mL, and the mismatch ratio was 1.
5.Which treatment plan would you choose for this patient? Option A: intravenous (IV) alteplase (0.
9mg/kg, the highest dose is 9mg, 10% of the total dose is injected within 1 minute, and the remaining dose is injected intravenously within 60 minutes) Option B is the use of tenecteplase (single The IV bolus dose is 0.
25 mg/kg, the highest dose is 25 mg) Option C Immediately take mechanical thrombectomy (MT) Option D Give 300 mg aspirin rectal suppository and send to the stroke ward Case 280-year-old female patient, normal body function before the onset of stroke , Sent to the hospital for acute stroke preparation at 8:30 in the morning.
At 8:00 that day, her husband was found to have hemiparesis with moderate aphasia.
Warfarin was previously used for mechanical mitral valve thrombosis, but he had stopped using it one month ago.
The initial NIHSS value is 7, the BP is 150/90mmHg, the blood oxygen saturation in the indoor air is 98%, the blood glucose concentration is 175mg/dL, the body temperature is 37 degrees Celsius, EKG shows atrial fibrillation, plain scan CT shows normal, no intravenous solution Suppository contraindications.
Which treatment plan would you choose for this patient? Option A IV Alteplase (0.
9mg/kg, the highest dose 90mg, 10% of the total dose is injected within 1 minute, and the remaining dose is intravenously injected within 60 minutes) Option B is injected intravenously with unfractionated heparin according to 80 units/kg After 18units/kg/hour perfusion, immediately transfer to a hospital that can perform thrombectomy, option C.
First perform insulin intravenous infusion to control blood sugar at 80-130mg/dL, and immediately transfer to a hospital that can perform thrombectomy.
Option D Immediately arranged to be transferred to the hospital for thrombectomy.
Case: A 348-year-old female patient who is right-handed and a telemarketer by profession.
She developed symptoms an hour ago and had numbness on her left side.
Previous history of hypertension, taking antihypertensive drugs, mild facial weakness on the left side, no dysphonia, accompanied by decreased light perception on the left face, previous history of hypertension, NIHSS value 2, ASPECTS value 10, BP 200/115mmHg, blood oxygen saturation in indoor air is 97%, blood glucose concentration is 88mg/dL, body temperature is 36.
8 degrees Celsius, EKG shows normal sinus rhythm, plain scan CT shows normal, and passed the bedside swallowing test. Which treatment plan would you choose for this patient? Option A IV Alteplase (0.
9mg/kg, the highest dose 90㎎, 10% of the total dose is injected within 1 minute, the remaining dose is intravenously completed within 60 minutes) Option B Intravenous infusion of nicardipine or clevidipine to reduce Blood pressure (systolic blood pressure SBP＜185mmHg, diastolic blood pressure DBP＜110mmHg), post IV alteplase (0.
9mg/kg, the highest dose 90mm, 10% of the total dose is injected within 1 minute, the remaining dose is injected intravenously within 60 minutes) ) Option C oral 300 mg clopidogrel and 75 mg aspirin Option D oral ticagrelor 180 mg case 475-year-old functionally intact male patient with previous coronary artery disease (undergoing coronary artery bypass grafting), high blood pressure, hyperlipidemia and 4 years There is a history of stroke (remaining dysphonia).
Waking up at 8:00 in the morning, the dysphonia worsened, and the left side of the organism was weak.
The last normal time (LKW) is 22:00 last night.
When the symptoms did not improve, his family members took him to ED.
Arrival time is 19:00, NIHSS value is 7 (dysphonia, left face, arm and thigh weakness), BP is 145/80mmHg, blood oxygen saturation in indoor air is 99%, blood glucose concentration is 110mg/dL, body temperature It was 37.
0 degrees Celsius, EKG showed normal sinus rhythm, plain CT excluded cerebral hemorrhage, and passed bedside swallowing test.
Which treatment plan would you choose for this patient? Option A: Oral 300 mg of aspirin and then transferred to the stroke ward Option B: Orally 300 mg of clopidogrel and 75 mg of aspirin, then transferred to the stroke ward Option C: Orally 180 mg of ticagrelor and 325 mg of aspirin, then transferred to the stroke ward Option D for STAT CT angiography and perfusion imaging
How to make a decision in these situations? The American Stroke Association (ASA) will teach you how to do the questions online, with the latest guide analysis~ Come and watch! Case: A 180-year-old female patient with well-functioning body suffered a sudden stroke at 5 o'clock in the afternoon of the day, causing weakness in the right limb and speech difficulties.
Two months ago, the patient felt weakness in his left arm and leg, but no other neurological symptoms.
He did not seek medical treatment, and his symptoms gradually eased after 4 weeks.
When the patient arrived at the hospital at 7 o'clock in the evening, the patient was already completely aphasia, left eye eccentric vision, right hemiplegia and decreased feeling.
He has a history of hypertension, the National Institutes of Health Stroke Scale (NIHSS) score is 24, blood pressure is 160/100mmHg, and blood sugar is 82mg/dL.
In indoor air, blood oxygen saturation is 99%, body temperature is 37 degrees Celsius, electrocardiogram (KEG) shows normal sinus rhythm, CT scan results show that the patient’s Alberta stroke plan early diagnosis score (ASPECTS) score is 10 The angiography (CTA) showed that the patient’s proximal middle cerebral artery (M1) was blocked.
CT perfusion imaging (CTP) was performed at 7:30 in the evening.
The results showed that the infarct volume with a peak time (Tmax)> 6 seconds was 45 mL, and the infarct volume with a blood flow (CBF) <30% was 30 mL, and the mismatch ratio was 1.
5.Which treatment plan would you choose for this patient? Option A: intravenous (IV) alteplase (0.
9mg/kg, the highest dose is 9mg, 10% of the total dose is injected within 1 minute, and the remaining dose is injected intravenously within 60 minutes) Option B is the use of tenecteplase (single The IV bolus dose is 0.
25 mg/kg, the highest dose is 25 mg) Option C Immediately take mechanical thrombectomy (MT) Option D Give 300 mg aspirin rectal suppository and send to the stroke ward Case 280-year-old female patient, normal body function before the onset of stroke , Sent to the hospital for acute stroke preparation at 8:30 in the morning.
At 8:00 that day, her husband was found to have hemiparesis with moderate aphasia.
Warfarin was previously used for mechanical mitral valve thrombosis, but he had stopped using it one month ago.
The initial NIHSS value is 7, the BP is 150/90mmHg, the blood oxygen saturation in the indoor air is 98%, the blood glucose concentration is 175mg/dL, the body temperature is 37 degrees Celsius, EKG shows atrial fibrillation, plain scan CT shows normal, no intravenous solution Suppository contraindications.
Which treatment plan would you choose for this patient? Option A IV Alteplase (0.
9mg/kg, the highest dose 90mg, 10% of the total dose is injected within 1 minute, and the remaining dose is intravenously injected within 60 minutes) Option B is injected intravenously with unfractionated heparin according to 80 units/kg After 18units/kg/hour perfusion, immediately transfer to a hospital that can perform thrombectomy, option C.
First perform insulin intravenous infusion to control blood sugar at 80-130mg/dL, and immediately transfer to a hospital that can perform thrombectomy.
Option D Immediately arranged to be transferred to the hospital for thrombectomy.
Case: A 348-year-old female patient who is right-handed and a telemarketer by profession.
She developed symptoms an hour ago and had numbness on her left side.
Previous history of hypertension, taking antihypertensive drugs, mild facial weakness on the left side, no dysphonia, accompanied by decreased light perception on the left face, previous history of hypertension, NIHSS value 2, ASPECTS value 10, BP 200/115mmHg, blood oxygen saturation in indoor air is 97%, blood glucose concentration is 88mg/dL, body temperature is 36.
8 degrees Celsius, EKG shows normal sinus rhythm, plain scan CT shows normal, and passed the bedside swallowing test. Which treatment plan would you choose for this patient? Option A IV Alteplase (0.
9mg/kg, the highest dose 90㎎, 10% of the total dose is injected within 1 minute, the remaining dose is intravenously completed within 60 minutes) Option B Intravenous infusion of nicardipine or clevidipine to reduce Blood pressure (systolic blood pressure SBP＜185mmHg, diastolic blood pressure DBP＜110mmHg), post IV alteplase (0.
9mg/kg, the highest dose 90mm, 10% of the total dose is injected within 1 minute, the remaining dose is injected intravenously within 60 minutes) ) Option C oral 300 mg clopidogrel and 75 mg aspirin Option D oral ticagrelor 180 mg case 475-year-old functionally intact male patient with previous coronary artery disease (undergoing coronary artery bypass grafting), high blood pressure, hyperlipidemia and 4 years There is a history of stroke (remaining dysphonia).
Waking up at 8:00 in the morning, the dysphonia worsened, and the left side of the organism was weak.
The last normal time (LKW) is 22:00 last night.
When the symptoms did not improve, his family members took him to ED.
Arrival time is 19:00, NIHSS value is 7 (dysphonia, left face, arm and thigh weakness), BP is 145/80mmHg, blood oxygen saturation in indoor air is 99%, blood glucose concentration is 110mg/dL, body temperature It was 37.
0 degrees Celsius, EKG showed normal sinus rhythm, plain CT excluded cerebral hemorrhage, and passed bedside swallowing test.
Which treatment plan would you choose for this patient? Option A: Oral 300 mg of aspirin and then transferred to the stroke ward Option B: Orally 300 mg of clopidogrel and 75 mg of aspirin, then transferred to the stroke ward Option C: Orally 180 mg of ticagrelor and 325 mg of aspirin, then transferred to the stroke ward Option D for STAT CT angiography and perfusion imaging
