Tpa

Question 0

When something is still in a research phase you call it

Answer 0

In the pipe line

Not for prime time

Question 1

Explain reperfusion injury concept

Answer 1

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

Question 2

Example of a method to reduce metabolic activity in acute stroke

Answer 2

Hypothermia

Question 3

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

Answer 3

Get in ct in 2 days

Question 4

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

Answer 4

13

Question 5

What do you see in the original studies with tpa efficacy

Answer 5

30% better in 3 months

Question 6

What is the time exclusion criteria for sx, stroke etc

Answer 6

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

Question 7

If you have patient with mi and stroke

Answer 7

Cardio consult

Question 8

If pt present with Todd’s paralysis or seizure

Answer 8

CTA, if you suspect seizure r o stroke

Question 9

What on ct excludes stroke

Answer 9

Nothing subtle

Question 10

When is consent required

Answer 10

When it is outside of std of care

If standard of care the excuse me bitched

Question 11

Abbreviation for tpa

Answer 11

Rt pa

Question 12

How do you mix tpa

Answer 12

1 to 1 with saline

Question 13

Administer tpa ptotocol

Answer 13

10 percent over 2 min

90 over 1 hr

Question 14

What is the dose of myocardial dose

Answer 14

1.1% mg kg

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

Question 15

How often do you check vitals

Answer 15

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

Question 16

After tpa what should bp be

Answer 16

160 to 180

80 to 100

Question 17

What makes you stop tpa and get ct

Answer 17

HA

N/v

Question 18

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

Answer 18

Restart drug

Treat headache

Question 19

3 things to look for after tpa 6

Answer 19

Vitals
Any pain head ache
N v
New weakness
Angio edema

Question 20

Why is sICH the most feared complication of tpa

Answer 20

45 percent death rate.

Question 21

Treatment of ICH bleed

Answer 21

6 units of cryo

6 units of platelets

Question 22

How often is angio edema associated with tpa

Answer 22

Up to 5 percent

Question 23

Who gets angio edema w tpa

Answer 23

Ace
Frontal
Insular

Question 24

Tell me about the study that supports 4.5 hr mark 5

Answer 24

``` Ecass 2008 hacke Small effect size N 400 Double blind ```

Question 25

When did 4.5 get approved

Answer 25

2008

Question 26

What were the three exclusion criterion for ecass

Answer 26

80 25 Hx of diabetes

Question 27

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

Answer 27

Absolute increase by 7 % 52 vs 45

Question 28

What is number needed to treat w at 4.5

Answer 28

14 for 4.5 8 for disability 3 for any benefit

Question 29

Hoe man get tpa nationally

Answer 29

2 to 8.5

Question 30

Treatment for angio edema

Answer 30

Stop tpa 50 mg Benadryl 50 mg ranitidine Refractory: resort solumedrol 100 mg Last ditch epinephrine nebulizer And stat ent cricotony

Question 31

How big is the effect size of tpa at 4.5

Answer 31

Midwest 7 percent but significant

Question 32

When do we give anti platelets with stroke

Answer 32

24 to 48 | By 1percent in 2 weeks

Question 33

How big was the effect size of Asa after tpa

Answer 33

1 percent in two weeks

Question 34

Has Asa show efficacy with treating stroke

Answer 34

No. Only secondary prevention

Question 35

What is the leading cause of disability in the us

Answer 35

Stroke cdc2005

Question 36

Proven ways to help rehab post stroke

Answer 36

``` Inpt rehab Early rehab Long term language pathologist Improve attention Treat depression And emotion liability ```

Question 37

What do you ask stroke pt durin follow up

Answer 37

``` Compliance Rehab Anxiety Snoring Sad ```

Question 38

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

Answer 38

1 hr

Question 39

Define a Lazarus effect

Answer 39

14 point improvement | In 24 hr

Question 40

How often does the Lazarus effect occur

Answer 40

20 in tpa 3 percent in control

Question 41

The most important factor in treating stroke is

Answer 41

90 min (Marley 2000)

Question 42

Why do thrombotics work.

Answer 42

They will recanalize the blood vessel

Question 43

What type of clots are unlikely dissolved by tpa

Answer 43

Distal internal Proximal mca Saqqur 2007

Question 44

What are three ways to protect stroke patients - neuroprotective

Answer 44

Hypothermia- (2002 Bernard et al) Magnesium ( saver 2004) High flow (singhal 2007)

Question 45

Factor associated with tpa failure 5

Answer 45

``` 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) ```

Question 46

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

Answer 46

Des mot e plase

Question 47

What thrombo lytic has long half life

Answer 47

Ret e plase

Question 48

What are some ways to improve tpa performance

Answer 48

Ultrasound enhancement

Question 49

How large was the effect size with tpa

Answer 49

12 percent more patient recovery

Question 50

Coolest new approach to enhancing tpa

Answer 50

Nano bubbles/tpa/ultrasound

Question 51

What is the problem with the intra arterial study

Answer 51

6 hr Proactive Ii Used prokinase

Question 52

When is intraarterial thrombolitic

Answer 52

Large vessel ica or mca

Question 53

What are the three types of Cather based devices

Answer 53

Endo vascular - suction Mechanical disruption- stent or laser Augmentum fibrolytics - ultrasound on catheter

Question 54

First clot retriever FDA approved

Answer 54

Merci 2005

Question 55

What is the tecanulization rate w stenting

Answer 55

80 perc

Question 56

What is the hemorrhage rate with merci

Answer 56

5percent | SAH from puncturing wall

Question 57

What is newest clot extractor

Answer 57

Penumbra system 100. Recanulized | Base 2008

Question 58

How does the penumbra system work

Answer 58

Suction/aspiration Ring if suction fail Catheter

Question 59

What kinD of clots do tpa dissolve

Answer 59

Love hanging fruit

Question 60

What is the rational for doing both tpa and catheter system

Answer 60

Tpa dissolves the low hanging fruit clearing the way for extractor

Question 61

How do you increase collateral blood flow

Answer 61

Increase bp

Question 62

Best way to increase blood pressure

Answer 62

Phenyl ephrine alpha 1 ag | No effect on pulse

Question 63

Side effects of phenyl ephephrine

Answer 63

Ischemic bowel Digital necrosis in poorly hydrated

Question 64

How long do you wait after spinal surgery?

Answer 64

90 days or three month

Question 65

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

Answer 65

3 months

Question 66

Dose of tpa for ais

Answer 66

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

Question 67

MI dose of tpa

Answer 67

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

Question 68

How many stroke survivors

Answer 68

7 million

Question 69

What percentage of stroke survivors go to extended care center

Answer 69

26 percent

Question 70

What percent of stroke or can walk after stroke

Answer 70

30 percent without walker

Question 71

What percent of stroke are aphasia

Answer 71

19 perc

Question 72

Cost of stroke in us 2010

Answer 72

74 billion

Question 73

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

Answer 73

Half the life time risk

Question 74

Smoker increases stroke risk by

Answer 74

2 to 4

Question 75

Afib increases likely hood of stroke by

Answer 75

5 fold

Question 76

How does pregnant affect stroke

Answer 76

Increases by 2.4 fold

Question 77

What perc of stroke survivors get another stroke in future

Answer 77

23 percent

Question 78

Who is more likely to have stroke men or women

Answer 78

Woman 45 to 54

Question 79

Does estrogen increase stroke risk

Answer 79

Yes by 44 percent

Question 80

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

Answer 80

Yes by 300

Question 81

What percent of strokes are hemorrhagic

Answer 81

13 hemorrhagic 3 SAH 10 intracerebral

Question 82

What percent of stroke is ischemic

Answer 82

87 percent

Question 83

Does a stroke age the brain

Answer 83

Yes by 4 each hour 1.9 million per min

Question 84

Area of infarct caused

Answer 84

Infarct

Question 85

What the name of tissue surrounding infarct

Answer 85

Penumbra

Question 86

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

Answer 86

360 million neurons die - brain does a 360 11 years older -

Question 87

What does occipital detect

Answer 87

Color discrimination | And motion- blink to threat

Question 88

Best distinguishing feature with mca stroke

Answer 88

Loc | Left gaze preference

Question 89

Posterior stroke signs

Answer 89

Cross findings Ipsilateral cn Contralateral motor

Question 90

Mortality rate of posterior stroke is

Answer 90

85 percent