This resource is a case-based simulation exercise focused on the emergency department evaluation and management of a patient presenting with an acute ischemic cerebrovascular accident (CVA). This educational tool involves one programmed high-fidelity simulation case of a patient with a left-sided CVA. Participants will be expected to manage the care of the patient. Debriefing materials for the management of an ischemic stroke consisting of some review of the literature surrounding the administration of intravenous tissue-type plasminogen activator (iv-TPA) are included. This case is intended to be used with emergency medicine residents, internal medicine residents, and senior-level medical students. The purpose is to prepare residents and students to appropriately manage a patient presenting to an emergency department with an ischemic CVA. This case was administered to approximately 15 emergency medicine residents as students. The goal of the case is to have the learners appropriately assess the patient with an acute CVA in a timely manner, obtain the appropriate imaging studies, evaluate indications and contraindications for a patient who is a potential candidate for iv-TPA, manage significant hypertension, and discuss with the patient the risks and benefits of iv-TPA. This simulation case also provides a venue for practicing departmental protocols surrounding the care of patients who present with acute CVA in a more realistic setting.
- Obtain a focused and appropriate history and physical in a patient suspected of having an acute ischemic cerebrovascular accident (CVA).
- Demonstrate understanding of indications and contraindications for the administration of intravenous tissue-type plasminogen activator.
- Provide appropriate therapies for patients with a diagnosis of acute CVA.
- Perform a National Institute of Health Stroke Scale.
- Understand diagnostic options for the evaluation of a patient suspected of having an acute CVA.
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