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Medical Emergencies > Acute Stroke > Flashcards

Acute Stroke Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the steps in the management of an acute stroke?

A
  1. Protect airway
  2. Maintain homeostasis
  3. Screen swallow
  4. CT head
  5. Anti-platelets
  6. Thrombolysis
  7. Thrombectomy
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2
Q

What is involved in maintaining homeostasis in acute stroke?

A
  • Keep blood glucose 4-11

- Only treat hypertension if hypertensive emergency or thrombolysis is considered

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3
Q

What BP should be aimed for if it’s treated in acute stroke?

A

180/110

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4
Q

What should be done until a swallowing screen is performed in acute stroke?

A

Keep patient NBM, but keep hydrated

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5
Q

How quickly should CT be done in acute stroke?

A

Within 1 hour if certain conditions, 24 hours otherwise

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6
Q

Under what conditions should CT head be done within 1 hour in acute stroke?

A
  • Thrombolysis considered
  • High risk of haemorrhage
  • Unusual presentation
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7
Q

What features show high risk of haemorrhage in acute stroke?

A
  • Decreased GCS
  • Signs of raised ICP
  • Severe headache
  • Meningism
  • Progressive symptoms
  • Bleeding tendency
  • Anticoagulated
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8
Q

What is considered to be an unusual presentation with stroke?

A
  • Fever

- Fluctuating consciousness

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9
Q

What is the advantage of CT in acute stroke?

A

Rules out haemorrhage

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10
Q

What is the advantage of MRI in acute stroke?

A

More sensitive for acute infarct

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11
Q

When should anti-platelets be given in acute stroke?

A

As soon as haemorrhagic stroke ruled out

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12
Q

What does of aspirin should be given in acute stroke?

A

300mg

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13
Q

How long should aspirin be continued for in acute stroke?

A

2 weeks (then start definitive anticoagulation)

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14
Q

When should thrombolysis be considered in acute stroke?

A

When haemorrhage is excluded

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15
Q

When are best results seen with thrombolysis?

A

Within 90 mins

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16
Q

What is the absolute latest time you can do thrombolysis?

A

4.5 hours after symptom onset

17
Q

What are the contraindications to thrombolysis?

A
  • Blood glucose <3 or >22
  • Known clotting disorder
  • Anticoagulants, or INR >1.7
  • Platelets <100
  • History of clotting disorder
18
Q

What can the contraindications to thrombolysis be divided into?

A
  • Factors relating to acute stroke
  • PMH
  • Clotting problems
  • Glucose
19
Q

What are the contraindications to thrombolysis that relate to features of the acute stroke?

A
  • Haemorrhage seen on CT
  • Mild/non-disabling deficit
  • Rapidly improving symptoms >180/105
  • BP >180/105
  • Seizures at presentation
20
Q

What are the contraindications to thrombolysis that relate to PMH?

A
  • Recent surgery, trauma, or artery/vein puncture at non-compressible site
  • Previous CNS bleeds
  • AVM/aneurysm
  • Stroke or serious head injury in last 3 months
  • GI/urinary tract haemorrhage in last 21 days
  • Severe liver disease, varices, or portal hypertension
  • History of intracranial neoplasm
21
Q

What are the contraindications to thrombolysis that relate to clotting problems?

A
  • Known clotting disorder
  • Anticoagulants, or INR >1.7
  • Platelets <100
  • History of clotting disorder
22
Q

What blood glucose is a contraindication to thrombolysis?

A

<3 or >22

23
Q

What is the agent of choice for stroke thrombolysis?

A

Alteplase

24
Q

What follow up needs to be done after thrombolysis?

A

CT 24 hours post-lysis

25
Q

When does thrombectomy provide additional benefit?

A

For those with large artery occlusion in proximal anterior circulation

26
Q

Can you do thrombectomy and thrombolysis together?

A

Yes (if within respective time frames)

27
Q

Within what time frame should thrombectomy be done?

A

6 hours

Medical Emergencies (10 decks)

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