Stroke Flashcards

1
Q

TIA vs Stroke

A

TIA: Focal neurologic deficit for <24 hours without acute infarction

Stroke: Focal neurologic deficit for >24 hours

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2
Q

Stroke Recognition

A

BE FAST
-Balance
-Eyes (trouble seeing)
-Face (drooping)
-Arms (drift down)
-Speech (slurring)
-Time (call 911 asap)

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3
Q

NIH Stroke Scale

A

5-15: mod stroke

16-20: mod to sev

20-42: severe stroke

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4
Q

General, Emergency Tx

A
  1. Manage BP
  2. IV Fibrinolytics
  3. O2, Temp, Glucose
  4. 2ndary Prevention (AP, AC, statin, BP)
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5
Q

Alteplase (TPA): CFU

A

Who is eligible?
-Age: 18+
-NIHSS > 5
-CT (-) for bleed
-Glucose 50-400
-BP < 185/110
-Sx < 4.5 hours

Door to needle time is 60 minutes

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6
Q

Alteplase: Dosing

A

0.9 mg/kg

Max 90 mg

Bolus: 0.09 (10%)

Infusion: 0.81 (90%)

ABW

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7
Q

Alteplase: AE, Monitoring

A

AE: bleeding, angioedema

Monitor: neuro exam, BP, bleeding, CT

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8
Q

Management of ICH w/in 24 hours after IV alteplase

A

-Stop alt infusion
-Cryoprecipitate 10 units IV
-Tranexamic acid or Aminocaproic acid
*help reverse altepase

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9
Q

AIS: BP Control

A

Qualifies for IV thrombolysis?

IF YES
-Lower to < 185/110 before giving thrombolysis
-Maintain < 180/105 for first 24 hours

IF NO
-BP <220/110: nothing
-BP >220/110: lower 15% in first 24 hours

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10
Q

AIS: BP MEDS

A
  1. Nicardipine 5 mg/hr
  2. Labetalol 10-20 mg
  3. Clevidipine 2 mg/hr
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11
Q

Antiplatelets: 2nd Prevention

A

For non-cardioembolic IS

  1. Aspirin 81-325 mg/day
  2. Dipyridamole ER + aspirin 1 cap BID
  3. Clopidogrel 75 mg
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12
Q

Anticoagulants: 2nd Prevention

A

For cardioembolic IS

  1. DOACs
  2. Warfarin ONLY in mitral stenosis or mechanical heart valves
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13
Q

Lipids: 2nd Prevention

A

High intensity
-Atorvastatin 40-80
-Rosuvastatin 20-40

CI: acute liver disease, preg/nursing

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14
Q

ICH: Warfarin Reversal

A
  1. hold warfarin therapy
  2. give one dose of Kcentra
    a. INR 2-3.9: 25 u
    b. INR 4-6: 35 u
    c. INR > 6: 50 u
  3. give IV Vitamin K (5-10 mg / 50 mL NS)
  4. FFP 10-15 ml/kg
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15
Q

ICH: Dabigatran Induced

A

Idarucizumab, Praxbind

2.5 g / 50 mL IV bolus over 6 min x 2 doses (total 5 g)

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16
Q

ICH: Riva/Apixa Induced + Dosing

A

Andexanet Alfa

Apixaban
-Over 5 mg and < 8 hours = 800 mg bolus, 8 mg/min infusion
-All others = 400 mg bolus, 4 mg/min infusion

Rivaroxaban
-Over 10 mg and < 8 hours = 800/8
-All others = 400/4

17
Q

Subarachnoid Hemorrhage (SAH)

A

SX
-Worst headache ever
-Stiff neck, NV

  1. Nimodipine
    -60 mg PO Q4h x 21 days
  2. Mg (can add to nimodipine)
    -0.5-1 g/hr IV inf