NREMT Paramedic Cognitive ExamMedicalMedium
A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided facial droop, left-sided arm weakness, and slurred speech. His last known normal (LKN) was 2 hours ago. His blood glucose is 110 mg/dL. Which of the following is the most critical prehospital action?
- AAdminister aspirin 325 mg orally.
- BMonitor blood pressure closely and treat aggressively if elevated.
- CRapid transport to a stroke-capable facility.
- DInitiate intravenous fluids at a KVO rate.
Show answer & explanationAnswer & explanation
Correct answer: C. Rapid transport to a stroke-capable facility.
The patient's sudden onset of focal neurological deficits (facial droop, arm weakness, slurred speech) with a known LKN within the therapeutic window for thrombolytics (typically 4.5 hours) strongly indicates an acute ischemic stroke. The most critical prehospital action is rapid transport to a stroke-capable facility where definitive diagnostic imaging and time-sensitive treatments (like thrombolytics) can be initiated.
Why the other options are wrong
- A. Aspirin is often given for ischemic stroke, but only after a CT scan rules out hemorrhagic stroke. Administering it prehospital without this information can be harmful if the stroke is hemorrhagic.
- B. While blood pressure management is crucial in stroke, aggressive treatment of elevated BP in the acute phase can sometimes worsen outcomes; it needs careful management, usually in the hospital setting. Rapid transport takes precedence.
- D. Intravenous fluids at a KVO (keep vein open) rate are appropriate for IV access, but not the most critical action. Aggressive fluid boluses are generally avoided in stroke unless hypotensive.
Acute Stroke Management
Emergency care for sudden neurological deficits caused by interruption of blood flow to the brain (ischemic) or bleeding in the brain (hemorrhagic), emphasizing time-sensitive intervention.
- Recognize stroke symptoms (FAST)
- Determine Last Known Normal (LKN) time
- Rapid transport to a stroke center for definitive care
Memory trick: FAST Exam, LKN Time, Race to Stroke Center!