Meningitis, TIA, stroke Flashcards
incidents that can lead to bacterial menigitis (3)
- skull fractures
- surgical procedures (local to area)
- ear/sinus/tooth infections
which type of menigitis is a more urgent situation?
bacterial
how do we prevent bacterial meningitis when we do brain surgery?
prophylactic antibiotics
bac meningitis has a high mortality rate if untreated within _____
24hrs
if a patient recently had enterovirus, arbovirus, has HIV, had mumps, or chickenpox, what might they be at risk for?
viral meningitis
patient presents with severe headache, fever, nausea and vomiting, and a peticheal rash. what else would I want to check to make a guess at diagnosis?
kernigs and bruudinski’s sign, are they photophobic? do they have nuchal rigidity
what is the main complication of menigitis?
decreased LOC eventually leading to coma
three dx for suspected meningitis
- blood cultures, CT scan, lumbar puncture and analysis of CSF (to confirm!)
when do we start antibitocis for meningitis?
Immediately as soon as we suspect it, even if it ends up being viral!
should a patient be on universal precautions for meningitis?
No, they will be on transmission precautions for 48hrs after abx initiated
three types of drugs besides abx for bacterial meningitis
steroids (dex), antipyretics, anticonvulsants
how long can a TIA last?
typically 30-60 minutes, but can last as long as 24 hrs
what should someone do when they have a TIA?
follow up with their dr to prevent future stroke
how do we assess risk for stroke following a TIA?
ABCD - age, (>60), BP (>140/90), Clinical TIA features, Duration of syptoms
what is a NIHSS score?
NIH stroke scale score
what are four stroke-preventing drugs?
platelet inhibitor (clopidogrel), anticoagulent (riveroxaban), antihypertensives, statins
two surgeries for recurrent stroke or high risk
transluminal angioplasty, carotid endarterectomy
what is ESSENTIAL during carotid endarterectomy?
BP management!
a patient is eligible for stroke treatment within _____ hrs
6
what happens if someone with a stroke is beyond the 6 hr point?
if under 24 hrs, risk v benefit of tx to be determined by stroke specialist
what are the two main interventions available for stroke?
fibrinolytics, endovascular interventions
whats the most important reason to know someone’s medication hx if they are presenting with stroke symmptoms?
because if its hemorhagic and they’re on anticoags, we may need to reverse them
what street drug increases risk of stroke?
cocaine
if a patient is to receive fibrinolytics, what is the recommended time since symptom onset?
maximum 4.5 hrs
during tPA infusion, how often do we do vitals?
q 15 for first hour, q 30 for 6 hr, etc. on ICU
what should BP be maintained at during tPA tx?
<185/110
during tPA, what should we NOT do?
insert a tube, give IM injectinos
three available endovascular interventions for stroke
- intra-arterial thrombolysis with tPA
- mechanical embolectomy
- carotid artery angioplasty with stent placement
pt teaching when d/c after a stroke
will be on anticoags, teach signs of bleeding, if on warfarin, teach about regular blood tests
treatment for hemorrhagic stroke (intracerebral)
repair bleeding vessel and remove blood, treat for IICP
whats the key thing to prevent with subarachnoid hemorrhage?
vasospasm!
what is the most common cuase of subarachnoid hemorrhage?
aneuryms
when is a vasospasm most likely to occur?
4-14 days after bleed/stroke
what’s the magic drug for vasospasm?
nimodipine - a ca channel blocker
why would we give nimodipine?
to prevent or treat vasospasm
besides nimodipine, how do we treat vasospams?
maintaining fluid and electrolyte status
