acute stroke and surgery Flashcards
Complications in acute phase
Malignant MCA syndrome-
Obstructive hydrocephalus
Haematoma expansion after ICH
Aspiration pnuemonia
Dehydration/electrolyte impairments/AKI
DVT- immobility increases risk
Recurrent strokes
Malignant MCA syndrome
tx
mostly anterior stroke
2-5 days post stroke usually but can be in 24h
younger patients bad cause less atrophy and space to accomodate swelling
tx- hemicraniectomy
cut hole in scull
Post stroke pneumonia
treatment
Commonly occurs within the first week
Usualy aspiration/hypostatic or both
tx- swallow screen, ng feeding good position
Dysphagia management
swallow screen and ng tube
tube down oesophagus and turns to go under diaphragm where stomach is
DVT prophylaxis
risk of PE
Heparin (including LMWH) reduces DVT risk but benefit is outweighed by bleeding risk
Intermittent pneumatic compression reduces risk of DVT compared to control - cuffs around legs
scoring system used to determine stroke risk in TIA
ABCD2
ischaemic stroke acute management
antiplatelets - aspirin/ clopidegril
and statins
Haemorrhagic strokes tx
stop any antithrombotics- antiplatelet/anticoagulant like clopirigril, warfarin, aspirin
BP management
blood thinners
anticoagulants- stop how fast clots form
heparin, warfirin
antiplatelet- aspirin, clopidegral
Acute blood pressure- when to do
Lowering BP for safe thrombolysis
ICH as an attempt to reduce haematoma expansion
pulmonary oedema
acute mi
aortic dissection
hypertensive encephalopathy
drugs ot reduce bp acutely
IV labetalol, IV GTN
Long Term Management
Lifestyle modification
Anti-platelets/anti-coagulation
Blood pressure
Diabetes
Statins
antiplatelets for secondary prevention
NIHSS<4= 300mg aspirin+ Clopidogrel 300 mg
followed by 75 mg daily of each for 3 weeks with Clopidogrel 75 mg daily to continue for life
more severe stroke- Aspirin 300 mg stat and 300 mg daily for 2 weeks followed by Clopidogrel 75 mg daily to continue for life
recurrent TIAs
if cause is atherosclerosis- genetic tetsing for clopidogrel resistance
treatment for AF caused stroke
NOT ASPIRIN
anticoag
