assessment and management of acute stroke Flashcards
(26 cards)
what is advertised in the fast campaign?
if there is a facial droop, a weakness in raising arms or slurred speech, need to ring 999 as soon as possible
describe the events that occur when a suspected stroke patient is reported from home to A&E
- paramedics called via a priority 1 call
- paramedics assess patient and if they believe the patient is having a stroke, they will alert the hospital via the batphone
- hospital will prealert the stroke team
- stroke team will meet patient in A&E and try adn determine stroke probability
what occurs when an acute stroke patient enters A&E?
met by the stroke team
focused history and examination ( including NIHSS)
initial investigations ( bloods and Iv access / ECG)
CT scan
what is a stroke?
a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of ceebral function lasting greater than 24 hours ( or leading to death) with no apparent cause other than that of vascular origin
when are the different types of stroke?
ischaemic stroke
intracerebral haemorrhage
TIA
what is the different classifications of stroke in the oxford classification of stroke?
TACS
PACS
LACS
POCS
what is the aetiology of TACS
Proximal 0cclusion (ICA or proximal MCA) Large volume infarct Superficial + deep territories
what is the presentation of TACS?
Higher cerebral dysfunction AND homonymous hemianopia AND ipsilateral motor +/- sensory deficit
what is the aetiology of PACS?
Occlusion of MCA
branch
Restricted infarct
what is the presentation of PACS?
2 out of 3 TACS deficits
OR higher cerebral
dysfunction alone OR
monoparesis
what is the aetiology of LACS?
Single perforating artery
Basal ganglia/pons
what is the presentation of LACS
Pure motor or pure
sensory, or ataxic
hemiparesis
what is the presentation of POCS
Cranial nerve palsy/
crossed signs/
cerebellar signs
what is the aetiology of POCS?
Posterior vessel
occlusion
(PCA or branches of
basilar/ vertebral)
What is the NIHSS score?
a way to objectively quantify the impairment caused by a stroke. Scored from 0 to 42. higher the score the more severe the stroke.
what are the limitations of a NIHSS score?
not a diagnostic tool
doesnt pick up many cranial nerve or cerebellar signs so can underestimate or miss a POCS
what are the advantages of NIHSS?
useful for showing the benefits of treatment/ progression of the stroke
why are CT scans useful in stroke patients?
to rule out haemorrhagic strokes - bright white (high attenuation) if blood present
Ischaemic stroke CT scans often appear normal
what is meant by reperfusion?
opening up the blocked vessel in ischaemic stroke to reperfuse the ischaemic brain
what is used to do thrombolysis in stroke?
alteplase given IV. Given as bolus and then rest over next hour
when is thrombolysis used to treat stroke?
clinical diagnosis of acute ischaemic stroke
CT imaging appears consistent with ischaemic stroke
symptom onset within 4.5 hours
no contraindications of high bleeding risk
what are the benefits of quick admission onto the hyper acute stroke unit?
Dysphagia screening (nursing staff)
Monitoring of neurological status and GCS
Cardiac monitoring
Early assessment by OT/Physio
Early mobilisation and discharge planning
SLT for detailed swallowing assessment and where
communication is impaired
Continence assessment
Nurses: insert NG tubes and monitor
Dietitian: monitor intake, prescribe NG regimes
Emotional and psychological support and education (Stroke
Association/ Neuro-psychology)
what is used as early secondary prevention after a stroke or TIA?
aspirin or clopidogrel if not in AF
initiate a statin
control BP
anticoagulate if in AF - DOACs now first line
carotid surgery - do carotid doppler ultrasound
how do we treat intracerebral haemorrhage?
Reversal of coagulopathy BP lowering (<150mmHg) if hypertensive Surgery only if: - haemorrhage with hydrocephalus - lobar haemorrhage with Glasgow Coma Score between 9 and 12 - cerebellar haemorrhage
