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Flashcards in FN: Stroke Management Deck (11):
1

Acute management

1. Resuscitate
2. Monitor
3. Imaging
4. Medical
5. Surgical
6. Stroke unit

2

Resuscitation

Airway - NGT
NBM until swallowing assessed
Dont overhydrate: risk of cerebral oedema

3

Monitor

1. Glucose:4-11mM: sliding scale if DM
2. BP: 185/110 (for thombolysis)
3. Neuro obs

4

Imaging

1. URgent CT/MRI
2. Diffusion-weighted MRI is most sensitive for acute infarct
3. CT will exclude primary haemorrhage

5

Medical

1. Consider thromboylsus if 18080 yrs and

6

Thrombolysis

Alteplase (eh-tPA)
Aspirin 300mg PO/PR once haemorrhagic stroke excluded ± PPI
Clopidgrel if aspirin sensitive

7

Surgery

Neurosurgical opinion if intracranial haemorrhage
May coil bleeding aneurysms
Decompressive hemicraniectomy for some forms of MCA infarction

8

Stroke unit

Specialist nursing and physio
Early mobilsation
DVT prophylaxis

9

Primary prevention

1. Control RFs: HTN, hypercholesterol, DM, smoking cardiac disease
2. Consider ife-long anticoagulation in AF (use CHADS2)
3. Carotid endarterectomy if symptomatic 70% stenosis
4. Excercise

10

Secondary PRevention

1. Risk Factor control as above - start statin after 4h
2. ASpirin/clopidogrel 300mg for 2 wks after stroke then either
a. clopidogrel 75mg OD (preferred option)
b. Aspiin 75mg OD + dipyridamole MR 200mg BD

3. Warfarin instead of aspirin/clopidegrel if
a. cardioembolic stroke or chronic AF
b. Start from 2 weeks post-stroke (INR 2-3)
c. Dont use aspirin and warfarin together

4. Carotid endarterectomy if good recovery + ipsilateral stenosis >70%

11

Rehabd

MENDS
MDT
Eating
Neurorehab
DVT
Sores

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