Acute Ischemic Stroke Flashcards
What fibrinolytic is the only FDA-approved for acute ischemic stroke
Altepase
What is a stroke, how is it diagnosed
CNS infarction involving cell death due to ischemia/ imaging/pathology OR clinical symptoms lasting greater than 24 hours or until death
What is ischemic stroke
an episode of neurological dysfunction caused by focal CNS infarction
What is intracerebral hemorrhage
Rapidly developing clinical signs of neurological dysfunction due to a non-traumatic focal collection of blood in the brain tissue or ventricular system that rapidly results in clinical sign of neurological dysfunction
What are the signs and symptoms of stroke
Sudden weakness, dizzines or difficulty walking/ sudden confusion or difficulty speaking/ sudden changes in vision/ sudden facial droop or numbness/ sudden severe headache
If a person is suspected to have a stroke what is acronymn used to identify and treat them
F: Face drooping after trying to smile
A: Arm weakness after trying to raise their arms
S: Speech difficulty
T: Time to call 911
What is a trans ischemic attack and how does it connect to a stroke
A brief period of neurological dyfunction caused by a focal distubance of brain or retinal ischemia with clincal symptoms lasting less than 1 hour and no evidence of of infarction while self resolving, major determinant of future stroke
What are the three prominent types of ischemic strokes
Thrombotic, Embolic, and cryptogenic
What are the stroke classifications based on location and what are their connected symptoms
Anterior cerebral artery (ACA): more weakness in the legs, confusion, mutism, poor judement
Middle cerebral artery (MCA): more weakness in the arms, dysarthria, aphasia, monocular vision loss
Posterior cerebral artery (PCA): 50% vision loss, CNIII palsy, memory loss
Vertebrobasilar system: cannot move but conscious, coma, blindness/vision changes, ataxia
What are the goals of therapy
Restore blood flow, Limit the area of ischemia. reverse neurological deficit, prevent complications, salvage the pneumbra
What are the initial managment treatments for stroke
Stabilized airway, breathing and circulation/ cardiac monitoring/ intravenous access/oxygen/ check for hypoglycemia/ history
What is time zero
The last time the patient did not have any symptoms of their stroke
What comorbid conditions increase the risk of stroke, what medications should be known about
Hypertension and diabetes/ anticoagulants, insulin, antihypertensives
What must be given before a person receives alteplase
CT scan to rule out hemorrhage and blood glucose
What is the NIH stroke scale, what are the prognostic value
a standardized and validated assesment tool for judging the severity of the stroke, 60-70% favorable outcomes in one year if score is less than 10 but 4-16% favorable outcomes in one year if score is greater than 20
What types of drug class is Alteplase, what is the dose
Recombinant tissue plasminogen activator, 0.9mg/kg IV for a max dose of 90 mg with 10% of the dose given over 1 minute while the remainder is infused over 1 hour
What are the contraindications of using alteplase to treat stroke
Onset of symptoms greater than 3 hours, improving symptoms, blood glucose less than 50 mg/dl, thrombocytopenia (less than 100,000), active bleeding or trauma
What are contraindications in the patient’s history that would not allow for alteplase use
Stroke, MI, or head trauma in the past 3 months/ GI bleed or urinary tract bleed in the last 21 days/ Surgery within 2 weeks, presence or history of intercranial hemorrhage
What are medication contraindications that can cause no alteplase use
Warfarin with INR greater than 1.7, Heparin with elevated PTT
What are neurological monitoring parameters for alteplase use
Every 15 minutes durign alteplase infusion, every 30 minutes thereafter for 6 hours, every 1 hour until 24 hours have passed
What blood pressure monitoring parameters for alteplase use, what must the blood pressure be below
Every 15 minutes during alteplase infusion for 2 hours, every 30 minutes after for 6 hours, every hour until 24 hours have passed/ less than 180/105
T/F: A CT scan must be done after 12 hours before starting any antithrombotic or anticoagulant
False: A CT scan after 24 hours before starting any antithrombotic or anticoagulant
T/F: Angioedmea and airway obstruction should be monitored for alteplase use
True
If alteplase cannot be used how high will the blood pressure be allowed to go, what can be given to lower the BP as intermittent therapy, continuous infusion
Up to 220/120, Labetalol and Hydralazine, Nitroprusside and Nicardipine
What stroke complication causes a sudden worsening of neurological exam, headache, nausea/vomiting, and acute HTN, what is done to treat it
Intracranial Hemorrhage/ STOP the alteplase infusion, START CT scan, SEND labs, Administer blood products 6-8 units of FFP or platelets if less than 100,000
What are characteristics of angioedmea after alteplase, what are the treatment options
acute swelling of the tongoue, lips with potential for airway compromise/ Antihistamines: Diphenhydramine AND Famotidine or Ranitidine, Corticosteroids: Methylprednisolone or Hydrocortisone, Epinephrine
T/F: Alteplase does not reduce mortality
True
What are procedures that can be done if a patient cannot be given alteplase
Intra-arterial thrombolysis, cerberal angioplasty, stent retriever
T/F: Urgent Heparin anticoagulation is recommended if stroke is present
False: Urgent anticoagulation is nOT recommedned if stroke is present
What are benefits of using asprin if they have had a stroke, when is given after alteplase use
less death, less recurrent stroke, no change in bleeding/ Asprin 325 mg can be started within 24-48 hours of stroke onset but Asprin should be for at least 24 hours after administering alteplase
What can be changed to make a patient eligible for alteplase
Blood pressure and blood glucose
What is the ABCD2, what are its parameters
Severitly of a TIA,
Age greater than 60
Blood Pressure greater than 140/90
Clinical features (unilateral weaknes and speech difficulty without weakness)
Duration greater than 60 minutes, 10-59 minutes
Diabetes
For a max of 7 points
What are the two parameters that have scores of 2, what is considered low risk, medium risk, high risk
Unilateral weakness and duration of TIA greater than one hour/ Low risk: 0-3, Medium risk: 4-5, High risk: 6-7
