Deviation in the Standard of Medical Care When Treating a Patient Having a Cerebral Vascular Accident (Stroke, CVA, TIA)

Evaluate breaches in the standard of care when there is a Deviation in the Standard of Medical Care When Treating a Patient Having a Cerebral Vascular Accident (Stroke, CVA, TIA)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was the patient's consciousness assessed upon presentation?
    Yes
    No
    Answer unknown
    Why is this important?
    The most typical presentation of hemorrhagic stroke is a split-second, overwhelming, very severe thunderclap-like headache. The symptoms of hemorrhagic cerebrovascular accident are due to bleeding from a vessel that leads to increased pressure within the cranium and compression of the brain. Loss of consciousness may occur.
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  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Clinical manifestations (neurologic deficits) of stroke will vary dependent upon what part of the brain is affected by the reduced blood flow. Symptoms and signs of stroke and TIA will adhere to one vascular distribution unless there is multifocal infarction.
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  • Were the airway, breathing and circulation stabilized? Why is this important?
    Answer this question
    The patient must be immediately managed according to the ABC (airway, breathing, circulation) principles. It must be ensured that airway, ventilation, and circulation are stable (ABCs).
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  • Was the patient’s blood pressure monitored? Why is this important?
    Answer this question
    The blood pressure must be monitored closely. Hypertension, unless critically severe must not be treated for the first 24 hours.
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  • Was a thorough medical history obtained and documented? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions that must be addressed at various points throughout the patient's lifetime.
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  • Was a complete physical examination performed? Why is this important?
    Answer this question
    A carefully focused physical examination serves as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Were diagnostic laboratory studies performed? Why is this important?
    Answer this question
    Routine laboratory studies provide important clues to diagnosis.
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  • Which of the following diagnostic studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    The main diagnostic investigation necessary is a head CT scan without contrast, which will facilitate differentiation between intra-cerebral hemorrhage, subarachnoid hemorrhage, and other non-hemorrhagic cerebrovascular disorders (e.g., ischemic stroke).
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  • With which type of stroke was the patient diagnosed? Why is this important?
    Answer this question
    Vital to achieving the optimal acute management of a stroke is the rapid and accurate determination of the type of stroke that has occurred, since treatment strategies for ischemic and hemorrhagic strokes differ significantly.
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  • Was the patient referred to a neurosurgeon? Why is this important?
    Answer this question
    Neurosurgery may be required to evacuate the hematoma and reduce the pressure within the cranium.
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  • Was the patient's blood pressure monitored and managed? Why is this important?
    Answer this question
    Hypertension and advanced age are the two most significant risk factors of hemorrhagic stroke.
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  • Was a surgical evacuation of the hematoma performed to relieve intra-cranial pressure? Why is this important?
    Answer this question
    The symptoms of hemorrhagic cerebrovascular accident are due to bleeding from a vessel that leads to increased pressure within the cranium and compression of the brain. Surgical evacuation of the hematoma may be performed to relieve compression.
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  • Was the patient referred for rehabilitation? Why is this important?
    Answer this question
    Rehabilitation is advised in all patients who have had incidents of a cerebrovascular accident, a TIA, or a subarachnoid hemorrhage.
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  • Did the patient undergo a cerebral angiography? Why is this important?
    Answer this question
    Digital subtraction angiography (DSA) is the recognized gold standard for the diagnosis of sub-arachnoid hemorrhage.
    (2010) 21 ENSCNA 2 305-323

  • Was nimodipine administered to the patient? Why is this important?
    Answer this question
    Nimodipine, a calcium channel blocker, is indicated for patients diagnosed with a subarachnoid hemorrhage to prevent further complications.
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  • Was surgical clipping chosen as the treatment of choice? Why is this important?
    Answer this question
    Surgery or endovascular treatment is usually required to prevent further episodes of SAH.
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  • Which of the following complications did the patient experience post-surgical clipping? Why is this important?
    Answer this question
    Craniotomy is a major surgical undertaking and is associated with significant morbidity and mortality. The patient may still have a residual neurologic or psychological deficit as a result of the SAH despite successful surgery. There is also a risk of developing seizures.
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  • Was endovascular coiling chosen as the treatment of choice? Why is this important?
    Answer this question
    Endovascular coiling involves embolization of the aneurysm. The procedure is usually performed under general anesthesia to ensure that the patient remains absolutely still as the coils are being released into the lumen of the aneurysm.
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  • Was a lumbar puncture performed on the patient with a suspicion of subarachnoid hemorrhage? Why is this important?
    Answer this question
    A lumbar puncture is indicated for patients with a high suspicion of subarachnoid hemorrhage with negative findings in the CT scan.
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