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TPA Pearls > Tpa > Flashcards

Tpa Flashcards

0
Q

When something is still in a research phase you call it

A

In the pipe line

Not for prime time

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1
Q

Explain reperfusion injury concept

A

If you restore blood flow to an infarct brain you are exposing a very vulnerable area of the brain to cytokines and free radical and neurotoxins

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2
Q

Example of a method to reduce metabolic activity in acute stroke

A

Hypothermia

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3
Q

If you can’t follow up a tpa w MRI what can you do

A

Get in ct in 2 days

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4
Q

How many patients do you have to treat w tpa to see an effect.

A

13

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5
Q

What do you see in the original studies with tpa efficacy

A

30% better in 3 months

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6
Q

What is the time exclusion criteria for sx, stroke etc

A

7 days - art line
14 days - peed and poop
21 days gi and
3 mo mi heal stoke

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7
Q

If you have patient with mi and stroke

A

Cardio consult

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8
Q

If pt present with Todd’s paralysis or seizure

A

CTA, if you suspect seizure r o stroke

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9
Q

What on ct excludes stroke

A

Nothing subtle

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10
Q

When is consent required

A

When it is outside of std of care

If standard of care the excuse me bitched

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11
Q

Abbreviation for tpa

A

Rt pa

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12
Q

How do you mix tpa

A

1 to 1 with saline

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13
Q

Administer tpa ptotocol

A

10 percent over 2 min

90 over 1 hr

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14
Q

What is the dose of myocardial dose

A

1.1% mg kg

Want it lower bc an ischemic brain is more likely to bleed than a cardia dose with a normal brain

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15
Q

How often do you check vitals

A

During tpa - 15
After tpa 30 for lucky seven
Than ever 1 hr for sexy sixteen

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16
Q

After tpa what should bp be

A

160 to 180

80 to 100

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17
Q

What makes you stop tpa and get ct

A

HA

N/v

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18
Q

If you get a stat ct and it’s negative.

A

Restart drug

Treat headache

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19
Q

3 things to look for after tpa 6

A 
Vitals
Any pain head ache
N v
New weakness
Angio edema
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20
Q

Why is sICH the most feared complication of tpa

A

45 percent death rate.

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21
Q

Treatment of ICH bleed

A

6 units of cryo

6 units of platelets

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22
Q

How often is angio edema associated with tpa

A

Up to 5 percent

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23
Q

Who gets angio edema w tpa

A

Ace
Frontal
Insular

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24
Q

Tell me about the study that supports 4.5 hr mark 5

A 
Ecass
2008 hacke
Small effect size
 N 400
Double blind
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25
Q

When did 4.5 get approved

A

2008

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26
Q

What were the three exclusion criterion for ecass

A

80
25
Hx of diabetes

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27
Q

What did they show as an effect size w tpa at 4.5

A

Absolute increase by 7 % 52 vs 45

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28
Q

What is number needed to treat w at 4.5

A

14 for 4.5
8 for disability
3 for any benefit

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29
Q

Hoe man get tpa nationally

A

2 to 8.5

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30
Q

Treatment for angio edema

A

Stop tpa
50 mg Benadryl
50 mg ranitidine

Refractory: resort solumedrol 100 mg

Last ditch epinephrine nebulizer
And stat ent cricotony

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31
Q

How big is the effect size of tpa at 4.5

A

Midwest 7 percent but significant

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32
Q

When do we give anti platelets with stroke

A

24 to 48

By 1percent in 2 weeks

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33
Q

How big was the effect size of Asa after tpa

A

1 percent in two weeks

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34
Q

Has Asa show efficacy with treating stroke

A

No. Only secondary prevention

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35
Q

What is the leading cause of disability in the us

A

Stroke cdc2005

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36
Q

Proven ways to help rehab post stroke

A 
Inpt rehab
Early rehab
Long term language pathologist
Improve attention
Treat depression
And emotion liability
37
Q

What do you ask stroke pt durin follow up

A 
Compliance
Rehab
Anxiety
Snoring
Sad
38
Q

How long do you need to wait before you put foley into a tpa pt

A

1 hr

39
Q

Define a Lazarus effect

A

14 point improvement

In 24 hr

40
Q

How often does the Lazarus effect occur

A

20 in tpa 3 percent in control

41
Q

The most important factor in treating stroke is

A

90 min (Marley 2000)

42
Q

Why do thrombotics work.

A

They will recanalize the blood vessel

43
Q

What type of clots are unlikely dissolved by tpa

A

Distal internal
Proximal mca
Saqqur 2007

44
Q

What are three ways to protect stroke patients - neuroprotective

A

Hypothermia- (2002 Bernard et al)

Magnesium ( saver 2004)

High flow (singhal 2007)

45
Q

Factor associated with tpa failure 5

A 
Clot is too big- clo burden
Clot is not blood - calcium dissection
Clot is at a dead end
Clot had a lot of platelets 
Clot is very organized and fibrotic)
46
Q

What is the name of the thrombo lytic made from vampire bats

A

Des mot e plase

47
Q

What thrombo lytic has long half life

A

Ret e plase

48
Q

What are some ways to improve tpa performance

A

Ultrasound enhancement

49
Q

How large was the effect size with tpa

A

12 percent more patient recovery

50
Q

Coolest new approach to enhancing tpa

A

Nano bubbles/tpa/ultrasound

51
Q

What is the problem with the intra arterial study

A

6 hr
Proactive Ii
Used prokinase

52
Q

When is intraarterial thrombolitic

A

Large vessel ica or mca

53
Q

What are the three types of Cather based devices

A

Endo vascular - suction

Mechanical disruption- stent or laser

Augmentum fibrolytics - ultrasound on catheter

54
Q

First clot retriever FDA approved

A

Merci 2005

55
Q

What is the tecanulization rate w stenting

A

80 perc

56
Q

What is the hemorrhage rate with merci

A

5percent

SAH from puncturing wall

57
Q

What is newest clot extractor

A

Penumbra system 100. Recanulized

Base 2008

58
Q

How does the penumbra system work

A

Suction/aspiration
Ring if suction fail
Catheter

59
Q

What kinD of clots do tpa dissolve

A

Love hanging fruit

60
Q

What is the rational for doing both tpa and catheter system

A

Tpa dissolves the low hanging fruit clearing the way for extractor

61
Q

How do you increase collateral blood flow

A

Increase bp

62
Q

Best way to increase blood pressure

A

Phenyl ephrine alpha 1 ag

No effect on pulse

63
Q

Side effects of phenyl ephephrine

A

Ischemic bowel

Digital necrosis in poorly hydrated

64
Q

How long do you wait after spinal surgery?

A

90 days or three month

65
Q

So for CNS sx who gets stroke how long do you wait until tpa

A

3 months

66
Q

Dose of tpa for ais

A

0.9 mg kg x kg. —— total
Give ten percent over 2 min
Give other over 60 min

67
Q

MI dose of tpa

A

Max is 100 mg

15 mg over 2 min

.75 x. Mg/kg max 50 over 30

0.5 mg/kg max 35 over 60

68
Q

How many stroke survivors

A

7 million

69
Q

What percentage of stroke survivors go to extended care center

A

26 percent

70
Q

What percent of stroke or can walk after stroke

A

30 percent without walker

71
Q

What percent of stroke are aphasia

A

19 perc

72
Q

Cost of stroke in us 2010

A

74 billion

73
Q

People with controlled bp have —- the risk of stroke 120/80

A

Half the life time risk

74
Q

Smoker increases stroke risk by

A

2 to 4

75
Q

Afib increases likely hood of stroke by

A

5 fold

76
Q

How does pregnant affect stroke

A

Increases by 2.4 fold

77
Q

What perc of stroke survivors get another stroke in future

A

23 percent

78
Q

Who is more likely to have stroke men or women

A

Woman 45 to 54

79
Q

Does estrogen increase stroke risk

A

Yes by 44 percent

80
Q

Does family history of a stroke under 65 increase my risk of stroke

A

Yes by 300

81
Q

What percent of strokes are hemorrhagic

A

13 hemorrhagic
3 SAH
10 intracerebral

82
Q

What percent of stroke is ischemic

A

87 percent

83
Q

Does a stroke age the brain

A

Yes by 4 each hour

1.9 million per min

84
Q

Area of infarct caused

A

Infarct

85
Q

What the name of tissue surrounding infarct

A

Penumbra

86
Q

If you wait 3 hrs before you treat stoke how does the brain change?

A

360 million neurons die - brain does a 360

87
Q

What does occipital detect

A

Color discrimination

And motion- blink to threat

88
Q

Best distinguishing feature with mca stroke

A

Loc

Left gaze preference

89
Q

Posterior stroke signs

A

Cross findings

Ipsilateral cn

Contralateral motor

90
Q

Mortality rate of posterior stroke is

A

85 percent

TPA Pearls (2 decks)

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