Acute Stroke Flashcards
(24 cards)
what is the blood pressure needed to administer a fibrinolytic?
bolus: LESS than 185/110
infusion: LESS than 180/105
what are five deficits a patient can experience after stroke?
hemiparesis
cognitive decline
depression
inability to ambulate without assistance
PTSD
what are some modifiable risk factors for stroke?
hypertension
smoking
diabetes
dyslipidemia
atrial arrythmias and non atrial cardiac conditions
asymptomatic carotid stenosis
sickle cell disease
postmenopausal hormonal therapy
oral contraceptives
physical inactivity
obesity
what are some risk factors for chadvasc score?
congetsive HF or LV ejection fraction <40%
HTN
age 65+
diabetes
previous stroke or TIA
Vascular disease
Female
what is the most important piece of info when asessing ischemic stroke?
time of symptom onset
**this determines what treatment the patient gets!!!
what are some signs pf sudden neurological deficit?
dypshaisa
what are the severity ratings of storke on the NIHSS scale?
0=no stroke symptoms
1-4= Minor stroke
5-15=moderate stroke
16-20=mod to severe stroke
21-42=severe stroke
what are the diagnostic tools for stroke and their function?
non contrast head CT scan-rules out hemorrhage
MRI-more sensitive at detecting early ischemic changes
examples of metabolic stroke mimics
hypo/hyperglycemia
hyponatremia
hepatic encephalopathy
drug OD
examples of psychiatric stroke mimics
conversion disorder and malingering(exageeration of symptoms, “faking it”)
examples of neurological stroke mimics
seizure/postictal state
complicated migraine
hypertensive encephalopathy
vertigo
transient glonbal amnesia
patient had a stroke 3 hours ago. what treatment should they get?
**w/in 4.5hours
Give IV fibrinolytic (alteplase or tenceteplase)
may need to do thrombectomy
when can a thrombectomy be performed/who is eligible?
patients presenting within 4.5 hours with a LARGE vessel occlusion of internal carotid artery, middle cerebral artery, and basilar artery
T/F regardless of the time frame fibrinolytics should be given to all stroke patients
FALSE, you can only give fibrinolytics if the stroke happened <4.5 hours ago
patient had a stroke 6 hours ago and its confirmed to be a large vessel occlusion. what tretament should be given?
Thrombectomy!
patient had a stroke 10 hours ago and its confirmed to be a small vessel occlusion. what treatment should be given?
Permissive HTN
Heparin infusion
when is permissive HTN allowed?
when patient meets exclusion criteria and does NOT get alteplase
what does permissive hTN entail?
blood pressure is NOT treated unless ABOVE 220/110 in and effort to perfuse the brain
what are the two severe complications of fibrinolytics?
symptomatic ICH and Angioedema
tretament regimen for symtomatic ICH
DC ALTEPLASE
give cryoprecipitate infusion10 units over 10-30 minutes
admin anti-fibrinolytics-tranexamic acid 1000 mg IV or aminocaproic acid 4-5 grams IV
treatment regimen for angioedema
***watch, intubate, and let swelling come down
maintain airway
HOLD ACE
give IV methylprednisolone 80-100 mg iV
Give IV diphenhydramine 50 mg
Give IV ranitidine or famotidine 20mg
Give epinephrine 0.3 ml
what is the regimen for post fibrinolytic care?
**frequent neurologi and blood pressure monitoring for 24 hours
HIGH DOSE STATIN FOR ALL PTS
ASPIRIN FOR ALL PTS
DVT ppx *24+hrs post alteplase
anticoagulation if patient had cardioembolic stroke or history of Afib
examples of High dose statins
secondary storke prevention
lifetyle and nutrion
limit alcohol intake’
dyslipidemia
HTN
smoking cessation
diabetes
