Brain Attack (Stroke) - Unit 3 Flashcards
What is a stroke?
It’s a cut off of blood supply to a part of the brain.
What are the two types of strokes?
Ischemic and Hemmorhagic
Strokes - higher in whites than blacks. T/F?
FALSE - Higher in blacks than whites.
Strokes kill almost ____ americans each year.
130,000
Stroke - leading cause of long-term disability. T/F?
True
Stroke care - Time lost = brain lost. T/F?
True
There is a high chance in reoccurrence of a stroke right after it has happened. T/F?
True
What does FAST stand for?
FACE.
ARMS.
SPEECH.
TIME.
What are some stroke risk factors that cannot be controlled?
Increasing age, gender (more women than men, especially after menopause), heredity and race, prior stroke, genetics.
What are some modifiable risk factors?
High blood pressure, cardiac disease (A-Fib?), lipids, diabetes, tobacco use, illegal drug use, life style factors
Stroke exam - worst headache ever?
Yes!
What are some diagnostic tools for stroke?
CT Scan with or without contrast (first stop on the diagnostic train!),
CTA, Mri, carotid doppler, EEG, EKG, ECHO, etc.
What is a TIA?
Transient Cerebral Ischemia - it’s a mini stroke that usually goes away after 24 hours.
What does a TIA signal?
A very high change of impending stroke.
Is there permanent damage with a TIA?
Nope!
What are two types of Ischemic Strokes?
Thrombotic and Embolic
Thrombotic Stroke - def
When does it typically happen?
Risk factors?
This is when a blood clot cuts off supply to the brain - it’s a thrombus. It typically happens during sleep.
Risk factors are large vessels, HTN
Embolic Stroke - def
What’s the onset?
Risk factors?
This is when a clot or fragment breaks loose, say from the heart, and travels to the brain.
It has a very quick onset.
Risk factors include endocarditis, A-Fib.
What is the ischemic cascade?
This is a series of biochemical reactions in the brain after ischemia is found. Like, no atp? –> anaerobic –> lactic acid, etc.
What are the major interventions for Ischemic Stroke?
We want to reestablish flow/rescue the ISCHEMIC PENUMBA
What is the Ischemic Penumbra?
Ok, so when someone has an ischemic stroke, there’s like a ball that forms around the tissue. The outer layer of the ball is dead, but for the next 3-6 hours, the inside of the ball is alive. After that period, the inside dies as well. We want to save as much as we can.
What drugs do we give for an ischemic stroke?
Antiplatelet therapy (Aspirin - given right away), Plavix) or Thrombolytic Therapy (TPA)
TPA - What is it used for? What’s important to know about it?
It’s for a block and it breaks the clot up. There’s a lot you have to cover with it - it is not for everyone (especially people with high BP, seizures, etc.) Also, it can be given only up to 3 hours after surgery. So, if the person wakes up with a stroke, they can’t get TPA because we don’t know about the timing.
Are there surgical options for the prevention of stroke?
There’s a carotid ultrasound and carotid endarterectomy, which is taking the plaque out of the artery.!
With a carotid endarterectomy, what is recovery like?
well since we’ve messed with their carotids, the baro/chemo receptors might get all out of whack so they may have some BP/HR problems. Staying overnight in a hospital tends to help this.
What are the three types of hemorrhagic stroke? Caused by or extension of…
Intracerebral Hemorrhage (ICH), caused by hypertension, cocaine, etc.
Intraventricular Hemorrhage (IVH), which is an extension of an ICH. This is not good.
Subarachnoid Hemorrhage (SAD) - caused by a ruptured aneurysm.
What is an aneurysm?
It’s a blood vessel that burst.
What are some common areas for an aneurysm?
The circle of willis/middle cerebral.
Once an aneurysm bleeds, there’s a 30-40% chance of death. T/F?
True
What’s a vasospasm in regards to an aneurysm?
Rebleeding/rupturing (Nimotop can help this!)
How can we manage an aneurysm?
Interventional radiology/coiling
With an aneurysm, is maintaining an equal I/O important?
yes
What is coiling?
This is when they put a coil - like this metal stuff - into an aneurysm. It blocks blood from coming!
Stroke scoring system - >20 = what?
BAD
What do we do in an assessment for stroke?
ABC’s, Level of consciousness, BP, symptom onset, correlate deficit with vascular distribution, area of brain, etc.
What’s part of the clinical picture for stroke management?
Focused neurological examination, ABCD (Airway, Breathing, Circulation, Disability), IV access, frequently monitor patient’s vitals (BP is super important), noromothermia, normal glycemic control, fluid resuscitation, imaging, evaluation for thrombolytic therapy, maintain a good airway, prevent secondary brain injury, etc.
