Stroke - Hon

Question 1

when and why is NIH stroke scale used?

Answer 1

Important if tPA or intra-arterial intervention is a consideration. Score ranges from 0 (normal) to 42 (coma) and can be used to predict hemorrhagic conversion. A score of less than 10 = 2-3% risk of hemorrhage. greater than 20 = 17% risk of hemorrhage

Question 2

In evaluation and management of acute stroke, what are main priorities? -

Answer 2

• Maintain airway, breathing, circulation
• elevated HOB to 30deg
• give O2 at 2L/NC
• Obtain vitas and establish IV with NS
• DO NOT GIVE glucose
• obtain labs
• EKG
• pt wt
• treat fever if present!
• obtain hx

Question 3

if a patient presents with a stroke, what are you likely to see on the STAT CT?

Answer 3

It may appear normal, because acute stroke due to ischemia does not show on a CT for up to 72 hours. If you do see stroke findings on a CT for a pt who just had a stroke, it’s likely the stroke is an old stroke .
- Thus if the CT does appear normal, consider tPA if you suspect it’s a stroke. Be cautious that there are other things that presents like stroke (eg. seisure post ictal, migraine, metabolic things liek hypo or hyperglycemia, hepatic abnormalities). rule those out first.

Question 4

In what clinical situation is warfarin or other anticoagulants indicated when a pt presents with stroke?

Answer 4

• Afib
• prosthetic
• MI
• Atrial septal defect
• hypercoagulable state
• large vessel disease
• aortic arch disease