18 - stroke and TIA Flashcards Preview

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Flashcards in 18 - stroke and TIA Deck (13)
1

5 Sx people should look out for

1. weakness or numbness
2. speech disturbances
3. visual disturbances, esp in one eye
4. severe HA
5. vertigo or loss of balance, especially with the above

2

4 key features to help predict stroke

1. LOC - normal or slightly decreased
2. ONSET - abrupt
3. Focal Sx - fit within a vascular distribution
4. headache - none or mild in ischemic

3

5 signs to think about something else

1. decreased LOC
2. gradual onset
3. fever
4. fluctriating
5. no focal signs

4

some stroke mimics

- seizure
- migraine - more gradual onset
- transient global amesia
- syncope
- hypoglycemia - usually more general
- metabolic encephalopathy - non focal and confused
- encephalitis - confusion and maybe fever
- subdural - less sudden
- bell palsy - peripheral nerve weakness - so frontalis also hit
- peripheral vertigo

5

5 steps in initial eval

1. ABC
2. breif neuro exam
3. Hx - time of onset!
4. PhX
- vitals
- head and neck for bruits
- CV
- resp and abdo
- skin and extremity
5. neuro exam

6

4 intial investigations

1. basic bloods
2. ECG
3. head CT
4. vascular imaging of carotid and vert. arts in 24hours

7

why vascular imaging

need to get endartectomy of >70% stenosis

8

early mgmt

ABCs
Postition lying down
NPO until swallow assessed
fluids- NS
cardiac monitors
o2>94%
antiplatelet
hypertension: no aggressive Tx
hypotension: look for underlying causes
hyperthermia - cool and antipyretics
anticoagulation - DVT prophylaxis with LMWH
hypoglycemia - target 5-10

9

3 antiplatelet therapies

1. ASA
- laoding of 325
- follow with 81mg
2. plavix
- loading of 300mg
- use if failed ASA
3. aggrenox and ASA
- for ASA failures

10

how long for TPA

4.5 hours, but best in 90minutes

11

conta to TPA

- hemmorage
- spine/head trauma in 3 months
- major surg in past 2 weeks
- art puncture in past 7 days
- PTT and INR
- other bleeding conditions
- low or high glucose

12

how to determine admission for TIA

ABCD2 score

13

how to determine need for antiocoag in afib

CHA2Ds2 score