haemorrhage

Question 1

patients with haemorhage who are on blood thinners

Answer 1

coagulation factor deficiency = give factor replacement
severe thrombocytopaaenia = give pltelets
if the patient is on warfarin therapy = give prothrombin complex concentrate, fresh frozen plasma and Vit K
seek advice from a haematologist if the patient is taking a DOAC

Question 2

blood pressure management for acute haemorrhage

Answer 2

urgently lower the blood pressure to reduce hematoma expansion

Question 3

if the patient is immobilised during haemorrhage

Answer 3

use an intermittent pneumatic compression device s prophylaxis for deep vein thrombosis
start low molecular weight heparin after 48 hours after the hemorrhage

Question 4

subarachnoid haemorrhage presents as

Answer 4

75% present as acute severe headache
the rest present with LOC
mortality is high, many patients die before reaching hospital

Question 5

minor subarachnoid bleed

Answer 5

20% of patients have a sudden headache several weeks before the cute event
thought to be due to a sentinel bleed, which is a minor subarachnoid bleed before the main rupture
if diagnosed at this early stage, the aneurysm can be treated while the patient is still clinically well

Question 6

for patients with suspected subarachnoid haemorrhage

Answer 6

is subarachnoid blood is seen on CT, this is diagnostic
normal CT does not exclude subarachnoid
if CT is inconclusive, arrange LP or MRI to look for blood products in the CSF

Question 7

mood issues following stroke

Answer 7

psychological problems are common in stroke patients and do not manifest until the patient is at home
treatinng low mood and depression can help functional recovery
emotionl lability: uncontrollable weeping or laughing, resolves in a few weeks usually

Question 8

driving after stroke

Answer 8

after stroke a person cnnot drive for 4 weeks, or 3 months if they drive a commercial vehicle
this applied even if the patient hs no detectable neurological deficit
patient must be assessed before driving again

Question 9

driving after a TIA

Answer 9

advised patients do not drive for 2 weeks and commercial drivers dont drive for 4 weeks

Question 10

where to check the driving rules

Answer 10

Austroads australia