Stroke

Question 1

Anatomy of a stroke

Answer 1

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: respiratory distress, Cheyne-stokes respiration (apnea, increase, then decrease in respirations, then apnea again)
Listen
Feel: trachea, percussion, expansion

O2, RR

Question 4

Circulation

Answer 4

Look:
Listen: heart, carotid bruit
Feel: pulse, CRT

Check wounds
Get IV access
FBC, UEs, LFTs, lipids, cholesterol, glucose, troponin, BNP, clotting, G&S,

Question 5

Disability

Answer 5

GCS (low)
temp
PEARL (unequal pupils?)
BM
Neuro exam: inilaterally increased or decreased tone
NBM if concerned of poor swallow
Urgent CT head

Question 6

Exposure

Answer 6

Question 7

Definitive Ix

Answer 7

If CT head shows no changes
DO BRAIN MRI

Once CT head rules out haemorhagic stroke:
* aspirin 300mg PO STAT
* thrombolysis with alteplase if
1. <80 years and <4.5 hours from start of symptoms
2. >80 years and <3 hours from start of symptoms

• physiotherapy and SALT input (swallow, speech, dietetic)
• cause? ambulatory ECG monitoring, echo, carotid artery doppler

On discharge
* After 2 weeks, switch from 300mg aspirin to 75mg clopidogrel
* statin (atorvostatin 80mg)
* antihypertensives
* anticoagulants if coexisting AF

Question 8

Haemmoragic stroke/ TIA

Answer 8

Reverse any anti-coagulation e.g. warfarin using Vit K and PTC, dabigatran call haematologist for Idarucizumab

Control BP: if SBP >150 give labetalol IV

TIA:
Aspirin 300mg, followed by 2 weeks of aspirin and then clopidogrel LT
Specialist assessment and Ix within 24 hours (if high risk), 1 week (if low risk)

Question 9

Management of stroke

Answer 9