stroke - assessment and management Flashcards
time is brain! FAST
outline the key pathway of a stroke patient from start of stroke to back home
call - ambulance - RAP phone - Focused history and stroke score NISSH - Bloods
then CT - ischemic or hemoraggic
if ischemic - thrombolysis or thrombecotmy o rlower BP
unless - time too late, blled risk ie anticoagulants
send to stroke ward for MDT care
SLT - swallow - stop aspiraiton risk and pneumonia
Pressure sore, constpation
therapy - occupation and speech and movement, physio
discharge home with care
stroke - defention
Stroke - ‘a clinical syndrome rapidly developing clinical signs of neurolgical disturbance lasting greater than 24 hours cause is vascular in origin
Pathology:
- Ischaemic stroke – occlusion of a an intracerebral vessel
(85% of all strokes)
- Intracerebral Haemorrhage – bleeding into the brain parenchyma (10 to15%)
- TIA – Transient occlusion of an intracerebral vessel - same as a stroke but shorter
the 4 oxford classifications
name them
TACS
PACS
LACS
POCS
outline the presentaiton of a TACS
Proximal 0cclusion (ICA or proximal MCA) arge volume infarct Superficial + deep territories
Higher cerebral dysfunction AND homonymous hemianopia AND contalateral motor +/- sensory deficit
outline the presentaiton of a PACS
Occlusion of MCA branch Restricted infarct
2 out of 3 TACS deficits OR higher cerebral dysfunction alone OR monoparesis
outline the presentaiton of a LACS
Single perforating artery Basal ganglia/pons
Pure motor or pure
sensory, or ataxic
hemiparesis
outline the presentaiton of a LACS
Posterior vessel
occlusion
(PCA or branches of
basilar/ vertebral)
Cranial nerve palsy/ crossed signs/ cerebellar signs
outline how to read a stroke ct scan
you may see a noraml head ct early on (no bleeding) - this means if signs are present its and acute ischemic stoke and so we can so thrombolysis or theombecotmy
if you can see lots of blood hemorrhagic
after the patient is stable what do we do ?
determine underlying cause such as an atrial fib or hypertension ect and start a treatment plan for this
what is the name of the thrombolytic drug ?
Actilyse
time is key with a sroke only undergo thrombolysis or ectomy pre 4.5 hours
bonus
read the outline of what is done at a hyperacute stroke unit
Dysphagia screening (nursing staff)
Monitoring of neurological status and GCS
Cardiac monitoring
Early assessment by OT/Physio
Early mobilisation and discharge planning
SLT for detailed swallowing assessment and where
communication is impaired
Continence assessment
Nurses: insert NG tubes and monitor
Dietitian: monitor intake, prescribe NG regimes
Emotional and psychological support and education (Stroke
Association/ Neuro-psychology)
secondary sroke prevention is key in stokes
this is also known as reccurence
outline how we do this ?
EARLY SECONDARY PREVENTION WORKS:
- Aspirin (or clopidigrel)
- Initiate Statin (16% RRR in stroke)
- Control BP (lowering by 12/6mm Hg equates to a 46% reduction in stroke risk). Target <130/85
we may need to -
- Anticoagulate if in AF
- Carotid Surgery (the sooner the better) - if great arteries v.stenosed
outline how we manage an intracerebral hemorrhage
Reversal of coagulopathy BP lowering (<150mmHg) if hypertensive
Management in an Acute Stroke Unit Specialist rehabilitation Routine carer involvement Education & training programs Intermittent pnuematic compression stockings (IPC) - to prevent venous thromboemboli when stationary in hospital
what are the complications of strokes and stroke treatment
Pneumonia
- Sit up
- Safe swallow?
Seizures
Pressure sores
- Prevention through positioning/ turning/ pressure
relief
Dehydration/ malnutrition
- IV fluids/ NG
Constipation
- Hydration/ laxitives/ enemas
Incontinence/ retention
Depression
Spasticity
