Stroke Flashcards
TIA vs Stroke
TIA: Focal neurologic deficit for <24 hours without acute infarction
Stroke: Focal neurologic deficit for >24 hours
Stroke Recognition
BE FAST
-Balance
-Eyes (trouble seeing)
-Face (drooping)
-Arms (drift down)
-Speech (slurring)
-Time (call 911 asap)
NIH Stroke Scale
5-15: mod stroke
16-20: mod to sev
20-42: severe stroke
General, Emergency Tx
- Manage BP
- IV Fibrinolytics
- O2, Temp, Glucose
- 2ndary Prevention (AP, AC, statin, BP)
Alteplase (TPA): CFU
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
Alteplase: Dosing
0.9 mg/kg
Max 90 mg
Bolus: 0.09 (10%)
Infusion: 0.81 (90%)
ABW
Alteplase: AE, Monitoring
AE: bleeding, angioedema
Monitor: neuro exam, BP, bleeding, CT
Management of ICH w/in 24 hours after IV alteplase
-Stop alt infusion
-Cryoprecipitate 10 units IV
-Tranexamic acid or Aminocaproic acid
*help reverse altepase
AIS: BP Control
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
AIS: BP MEDS
- Nicardipine 5 mg/hr
- Labetalol 10-20 mg
- Clevidipine 2 mg/hr
Antiplatelets: 2nd Prevention
For non-cardioembolic IS
- Aspirin 81-325 mg/day
- Dipyridamole ER + aspirin 1 cap BID
- Clopidogrel 75 mg
Anticoagulants: 2nd Prevention
For cardioembolic IS
- DOACs
- Warfarin ONLY in mitral stenosis or mechanical heart valves
Lipids: 2nd Prevention
High intensity
-Atorvastatin 40-80
-Rosuvastatin 20-40
CI: acute liver disease, preg/nursing
ICH: Warfarin Reversal
- hold warfarin therapy
- give one dose of Kcentra
a. INR 2-3.9: 25 u
b. INR 4-6: 35 u
c. INR > 6: 50 u - give IV Vitamin K (5-10 mg / 50 mL NS)
- FFP 10-15 ml/kg
ICH: Dabigatran Induced
Idarucizumab, Praxbind
2.5 g / 50 mL IV bolus over 6 min x 2 doses (total 5 g)