NREMT Paramedic Cognitive ExamMedicalEasy
A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided weakness, facial droop, and expressive aphasia. His blood pressure is 180/100 mmHg, heart rate 88 bpm, respirations 16 breaths/min, and SpO2 98% on room air. Pupils are equal and reactive. What is the MOST appropriate initial management for this patient?
- ARapid transport to a stroke-capable facility.
- BPerform a blood glucose check and administer oral glucose if indicated.
- CAdminister intravenous fluids at a TKO rate.
- DAdminister aspirin 325 mg orally.
Show answer & explanationAnswer & explanation
Correct answer: A. Rapid transport to a stroke-capable facility.
This patient is exhibiting classic signs of an acute ischemic stroke. Rapid transport to a stroke-capable facility is critical for time-sensitive interventions like thrombolytic therapy or thrombectomy.
Why the other options are wrong
- B. While a blood glucose check is important to rule out hypoglycemia mimicking stroke, it is not the MOST appropriate initial management, and oral glucose is only indicated for confirmed hypoglycemia in a conscious patient.
- C. Intravenous fluids at TKO rate are generally appropriate, but not the MOST appropriate initial management given the time-sensitive nature of stroke. Overhydration can also be detrimental.
- D. Aspirin is contraindicated in hemorrhagic stroke and should only be given after CT confirmation of ischemic stroke. Administering it prehospital without this knowledge is inappropriate.
Acute Stroke Management
Acute stroke management focuses on rapid recognition of stroke symptoms, immediate assessment, and swift transport to a specialized stroke center for definitive treatment.
- Time is brain: every minute counts in stroke.
- Prehospital goal: rapid identification and transport.
- Avoid interventions that delay transport (e.g., extensive scene time).
Memory trick: FAST transport saves brains, don't delay!