Additional Qs Flashcards
What is a thrombectomy and when do you perform thrombectomy?
Thrombectomy, also known as mechanical clot retrieval
, is the surgical removal of a blood clot in an artery.
It is used to treat some strokes caused by a blood clot (ischaemic stroke) and it aims to restore blood flow to the brain. During the procedure, a specially-designed clot removal device is inserted.
2 types of strokes
Ischemic and Hemorrhagic
Ischemic is a blood clot in the blood vessel or a blockage in the blood vessel and is the most common type.
Hemorrhagic is a leakage or bursting of a blood vessel
4 types of brain bleed
Subdural hematoma
Epidural hematoma
Intracerebral hemorrhage
Subarachnoid hemorrhage
What is the difference between HEMATOMA vs haemorrhage?
A hematoma usually describes bleeding which has more or less clotted, whereas a hemorrhage signifies active, ongoing bleeding.
What would you do if someone was starting as a band 5?
- Introduce them to the team. (point of contact)
- Tour of A&E, resus, generals, & fire exits for safety
- Show s drive, local guidelines, protocols/justification, e learning
- Give dosimeter, personal dosimeter - find spare one.
- Sort out log ins/ smart card.
- Discuss the current changes within the department so they’re able to adjust with ease.
Further imaging for stroke?
NON CONTRAST CT HEAD is preferred initial study of acute strokes - within 3 hrs
Contrast enhanced CT should be done with CT angiography of the neck? For follow up
CT Stroke protocol
ischemic stroke -emergency imaging - diagnose patients. Urgent treatment-
1.Non con CT head
CT perfusion
Ct angio
1.assess brain for infarcts
2. Determine location of arterial blockage
3. Assess vascular anatomy
CT ANGio
From the aorta to the vertex of skull- CEREBRAL ARTERIES!
USING ARTERIAL PHASE OF IV CONTRAST
1. ARTERIAL DISSECTION
2. OCCLUSIVE THROMBOEMBOLISM
3. ANEURYSM
4. SUBARACHNOID HEMORRHAGE
CT Perfusion
enables the differentiation of salvageable ischaemic brain tissue (the penumbra) from the irrevocably damaged infarcted brain (the infarct core). This is useful when assessing a patient for treatment (thrombolysis or clot retrieval).
What will you do if A NGT has been dislodged?
risk of aspiration, interruptions in nutritional support, skin breakdown and radiographic exposure [1]. It
It is essential that prior to administration of feed/medications/water a pH of 5.5 or below is gained. is recommended that the
position of nasogastric tubes should be confirmed by aspiration and pH testing,
with radiographic confirmation used only when this is not possible
What do you know about MRI SAFETY?
Metal is not allowed.
Pacemakers
Aneurysm clip
Stent
Contrast side effects
/contrast-induced nephropathy (CIN)?
Mild hypersensitivity reactions consist of immediate skin rashes, flushing or urticaria pruritus,, nausea, brief retching, and/or vomiting, diaphoresis, coughing and dizziness;
moderate to severe (incidence <0.04%) reactions include persistent vomiting, diffuse urticaria, headache, facial edema, laryngeal edema, mild bronchospasm or dyspnea, palpitations, tachycardia or bradycardia, abdominal cramps, angioedema, coronary artery spasm, hypertension or hypotension, life-threatening cardiac arrhythmias (i.e. ventricular tachycardia), overt bronchospasm, laryngeal edema, cardiac failure and loss of consciousness, pulmonary edema, seizures, syncope.
Severe
- acute renal failure occurring -within 24–72 hrs of exposure to RCM
What things would you consider if you were to set up an X-RAY room?
consider the budget.
Check the size of machines if it’s suitable to the size of the X-ray room
Make rules and regulations regarding the use of machines and I.R to be safe
Work with medical physics regarding radiation safety
Consider the maintenance and warranty service in case it breaks
Easy to access/ get parts just in case if something breaks
Do they offer training and does it come with a package of aftercare?
Pulmonary Embolism?
CTPA
Do a CTPA to see if there is an embolus. You see it filling with contrast. PE is detected -give them blood thinners to thin clot. DISSOLVE BLOOD CLOT
To see diagnostic density of the main pulmonary artery and its branches.
technique is based on the detection of filling defects in the pulmonary arterial vasculature 6, so acquisition at the right time is of vital importance. The study is optimal when the pulmonary arteries are opacified, and the aorta is not.
When do you perform a thrombolysis and when do you perform thrombectomy?
bothare minimally invasive procedures that specialists perform to treat and remove a blood clot from
the clotting needs to be treated to restore blood flow. These treatments include :
Thrombolysis which involves the use of clot-busting medications which are injected directly into the clot to dissolve it.
Thrombectomy utilizes an angioplasty balloon catheter, and perhaps a specialized mechanical device to break up and remove the blood clot from the fistula or graft.
Contraindication -intracranial haemorrhage on initial non-contrast CT
large infarct core with no significant penumbra (i.e. no salvageable brain)
Thrombectomy-
Non con CT head to exclude hemorrhage
Then do CTA - CHECK FOR LARGE VESSEL OCCLUSION - THROMBECTOMY IS PERFORMED
If SMALL OCCLUSION IN ARTERY- THROMBOLISE - HOPING THE CLOT WILL MELT
Monitor patient to avoid complications
