stroke Flashcards
what is ischemic stroke
an infarction of brain tissue resulting from compromised blood flow
Risk factors for stroke
Age
family history
gender
race
low birth weight
sickle cell disease
Cardiovascular disease, Afib, diabetes, hyperlipidemia, hypertension, drug use, obesity, alcohol use, cigarette use
Clinical presentation of stroke
Dysphasia, facial droop, unilateral or bilateral weakness, ataxia, vision changes, headache
Assessment
CT or MRI will tell us if it is an ischemic stroke or a hemorrhagic stroke
If it is a ischemic stroke we then need to do an ECG and if the ECG shows Afib it is cardioembolic and if ECG is normal then atherosclerotic
Acute ischemic stroke management - Glycemic control
BP goal is <180mg/dL
If BP goes over 180 give subQ insulin
Acute ischemic stroke management - Blood Pressure
Check BP Q15min x 2H then Q30min x 6H, then Q1H for 16H
in first 24 hours goals
tPA given : <180/105 mmHg
NO tPA: <220/110mmHg
After first 24-48 hours
<160/90
After that
<130/80 or <140/90
Acute ischemic stroke management - blood pressure treatment
Labetalol IV
Nicardipine IV
Sodium nitroprusside IV
If BP is elevated after 48 hours start PO medications
Acute ischemic stroke management - thrombolytics
ONLY in patients meeting elegibility criteria
Inclusion criteria: Diagnosed ischemic stroke, onset of symptoms less than or equal to 4.5 hours
Exclusion criteria: Anything that increases bleeding ( surgery, GI bleed, MI in the past 3 months), Blood pressure: >185/110, Blood glucose: <50
Acute ischemic stroke management - Thrombolytics treatment
Alteplase: 0.9mg/kg IV (MAX 90mg) - give 10% over 1 minute and 90% over 60 minutes
Tenecteplase: 0.25mg/kg IV (max dosing 25mg)
IF PATIENT IS 100KG OR MORE ONLY USE MAX DOSING NO LONGER WEIGHT BASED
Keep blood pressure <180/105mmHg
Acute ischemic stroke management - Antiplatelets treatment
Aspirin - First line high dose for 2-4 weeks
Aspirin + Clopidogrel - for minor stroke second line (baby aspirin dose and 75mg QD of clo)
Ticagrelor - Second line (use for true aspirin allergy)
Must give 24 hours after tPA if administered
Acute Cardioembolic ischemic stroke management - Anticoagulants
Acute Hemorrhagic ischemic stroke management - Hypertensive goal
Treat if SBP >180
Goal BP first 24Hrs <180/110 mmHg
Goal BP after 24hrs <160/90
after 48 hours <130/80 or <140/90
Subarachnoid Hemorrhagic - prevention of vasospasm
Nimodipine 60mg orally Q4H for 21 days
Secondary Stroke prevention for Atherosclerotic
After completing high dose aspiring for 2-4 weeks will do 81mg baby aspirin for the rest of their lives
Can also do Dipyridamole/aspirin as first line instead of ASA 81mg
Secondary stroke prevention for cardioembolic stroke
patient will be put on aspirin for 2-14 days until anticoag treatment is recommended and then will start a DOAC unless they have mechanical mitral valve/LV thrombus then use warfarin
