Acute Stroke Treatment Flashcards
1
Q
Admission to the hyper acute stroke unit
A
- just over half of patients in the uk are able to access HASU
- 8 units accross london
- prior patients go to a&e and assessed by on call stroke team
- head scan and diagnoses withing 30 mins of arrival
- if stroke diagnosed sent to HASU for critical care treatment and typically stay less than 72 hours
2
Q
Diagnosis of stroke
A
- CT or MRI
- blood tests
- chest x ray
- ECG
- carotid doppler ultrasound
- echocardiogram
3
Q
Ischaemic and haemorrhagic stroke
A
If diagnosed care pathway determined
- close monitoring
- checks on bp, temp, hr, resp rate
- nurses monitor blood sugar levels and spo2
- mobility assessment
- communication and cognitive assessments
- pressure risk assessment = pressure sores
- continence assessment
- swallowing screening
4
Q
Ischaemic stroke treatment
A
- 87% of all strokes
- either thrombotic (blood clot in vessels in brain)
- or embolic (blood clot or debris develops elswhere in the body and travels to brain)
- medication used to treat and reduce the risk of it happening again
- some taken immediately and short term others later and long term
5
Q
Thrombolysis
A
- alteplase - dissolves blood clots and restores blood flow to the brain
- most effective when started asap after the stroke
- not reccomended if more than 4.5 hours have pass d
- brain scan must be carried out before hand to confirm diagnosis of ischaemic stroke
- can make haemorrhagic strokes worse
- if thromolysed better chance of being dissability free after 3 months
6
Q
Thrombectomy
A
- emergency procedure to remove blood clots
- restores blood flow to the brain
- insert catheter into an artery (often upper right thigh)
- stent retriever pushed to clot site and traps clot in cage
- then removes both the stent and the clot restoring blood flow
7
Q
Decompressive hemicraniectomy
A
- proportion of skull removed to relief intercranial pressure
- prevents neuronal damage in other regions of yourbbrsin
- bone stored and replaced when appropriate
- helmet and temp implant to protect brain and prevent further damage
8
Q
Carotid Endartectomy
A
- surgery to unblock carotid artery
- incision in neck to open carotid and remove fatty deposits
- close with stitches or patch
9
Q
Antiplatelets
A
- medication to soften a clot and reduce risk of further stroke
- most people offered aspirin - 300mg
- other antiplatelt such as clopidogrel and dipyridamole
10
Q
Anticoagulants
A
- medication to reduce further risk of stroke
- change the chemical composition of blood in a way that orevents blood clots occuring
- warfarin, apixaban, dabugatran, edoxaban, rivaroxaban
11
Q
Statins
A
- medication to lower cholesterol levels
- block a chemical in the liver that produces cholesterol
12
Q
Haeomorrhagic stroke - treatment
A
Divided into two main categories
- intracerebral haemorrhage (10%) bleeding fron blood vessels in the brain
- subarachnoid haemorrhage (3%)
13
Q
Intracerebral haemorrhage
A
ICH - diseased blood vessel in the brain bursts
- high blood pressure is the most common cause
- in younger people, abnormally formed blood vessels are another common cause (arterio-venous malformation)
- if ammount of blood increases rapidly the sudden increase in pressure can lead to unconsciousness or death
- if blood pressure too high 200mmhg systolic (hypertensive emergency) medicine given to lower it
- can lead to hydrocephalus, shunt can be placed to allow fluid to drain properly
14
Q
Subarachnoid haemorrhage
A
- bleeding in the subarachnoid space
- emergency surgery to remove blood from the brain
- craniotomy under general anaesthetic
- if scan shows SAH was caused by a brain aneurysm procedure to repair blood vessle and prevent aneurysm from bleeding is reccomended
15
Q
Neurosurgical clipping
A
- craniotomy
- when the aneurysm was located it would have been seales shut using a metal clip that stays permanently clamped on the aneurysm
- bone flap replaced and scalp stitched
- over time blood vessel lining heals along where the clip is placed sealing the aneurysm
