Acute Stroke

Question 1

what is the blood pressure needed to administer a fibrinolytic?

Answer 1

bolus: LESS than 185/110
infusion: LESS than 180/105

Question 2

what are five deficits a patient can experience after stroke?

Answer 2

hemiparesis
cognitive decline
depression
inability to ambulate without assistance
PTSD

Question 3

what are some modifiable risk factors for stroke?

Answer 3

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

Question 4

what are some risk factors for chadvasc score?

Answer 4

congetsive HF or LV ejection fraction <40%
HTN
age 65+
diabetes
previous stroke or TIA
Vascular disease
Female

Question 5

what is the most important piece of info when asessing ischemic stroke?

Answer 5

time of symptom onset
**this determines what treatment the patient gets!!!

Question 6

what are some signs pf sudden neurological deficit?

Answer 6

dypshaisa

Question 7

what are the severity ratings of storke on the NIHSS scale?

Answer 7

0=no stroke symptoms
1-4= Minor stroke
5-15=moderate stroke
16-20=mod to severe stroke
21-42=severe stroke

Question 8

what are the diagnostic tools for stroke and their function?

Answer 8

non contrast head CT scan-rules out hemorrhage
MRI-more sensitive at detecting early ischemic changes

Question 9

examples of metabolic stroke mimics

Answer 9

hypo/hyperglycemia
hyponatremia
hepatic encephalopathy
drug OD

Question 10

examples of psychiatric stroke mimics

Answer 10

conversion disorder and malingering(exageeration of symptoms, “faking it”)

Question 11

examples of neurological stroke mimics

Answer 11

seizure/postictal state
complicated migraine
hypertensive encephalopathy
vertigo
transient glonbal amnesia

Question 12

patient had a stroke 3 hours ago. what treatment should they get?

Answer 12

**w/in 4.5hours
Give IV fibrinolytic (alteplase or tenceteplase)
may need to do thrombectomy

Question 13

when can a thrombectomy be performed/who is eligible?

Answer 13

patients presenting within 4.5 hours with a LARGE vessel occlusion of internal carotid artery, middle cerebral artery, and basilar artery

Question 14

T/F regardless of the time frame fibrinolytics should be given to all stroke patients

Answer 14

FALSE, you can only give fibrinolytics if the stroke happened <4.5 hours ago

Question 15

patient had a stroke 6 hours ago and its confirmed to be a large vessel occlusion. what tretament should be given?

Answer 15

Thrombectomy!

Question 16

patient had a stroke 10 hours ago and its confirmed to be a small vessel occlusion. what treatment should be given?

Answer 16

Permissive HTN
Heparin infusion

Question 17

when is permissive HTN allowed?

Answer 17

when patient meets exclusion criteria and does NOT get alteplase

Question 18

what does permissive hTN entail?

Answer 18

blood pressure is NOT treated unless ABOVE 220/110 in and effort to perfuse the brain

Question 19

what are the two severe complications of fibrinolytics?

Answer 19

symptomatic ICH and Angioedema

Question 20

tretament regimen for symtomatic ICH

Answer 20

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

Question 21

treatment regimen for angioedema

Answer 21

***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

Question 22

what is the regimen for post fibrinolytic care?

Answer 22

**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

Question 23

examples of High dose statins

Question 24

secondary storke prevention

Answer 24

lifetyle and nutrion
limit alcohol intake’
dyslipidemia
HTN
smoking cessation
diabetes