Stroke Management Flashcards
1
Q
Stroke Presentation
A
- abrupt onset of focal neurologic symptoms & signs
- evaluate & stabilize vital signs (BP, HR, Vent, T)
2
Q
Stroke History
A
- HxPI - time of symptom onset, progression, headache - formulate anatomic Dx
- PMHx - stroke risk factors, medications
- FHx - vascular disease, HTN, hyperlipideia
- SHx - tabacco, EtOH, illicit drugs
3
Q
Stroke Exam
A
- medical examination - provides info on pathogenesis or etiology, heart rate & rhythm, BP in both arms, listen for carotid bruits, peripheral vascular exam
- Neuro: info on lesion location
- Working diagnosis: stroke or other cause, ischemic vs. hemorrhagic, vascular territory, etiology
4
Q
Stroke Labs
A
- EKG with rhythm strip
- Chest x-ray to evaluate heart size
- CBC with differential & platelet count
- Chemistry profile (glucose, BUN, electrolytes)
- Lipid profile
- Clotting times (INR, aPTT)
- Head CT without contrast
5
Q
Other Stroke lab Values
A
- RPR
- Coag (lupus, anticardiolipin Ab, protein C & S activity, factor V leiden)
- Viscosity tests: blood viscosity, protein electrophoresis
- Vascultis: ESR especially in elderly, FANA, etc.
- Homocysteine levels
- Urine drug screen
6
Q
Radiologic Evaluation of Stroke
A
- Echo
- Carotid artery ultrasound
- Head MRI
- Head & Neck MRA
- CT arteriogram
- Digital subtraction arteriogram
7
Q
Digital Subtraction Arteriography
A
-interventiaonal neuroradiographic methods for catheter placement via the femoral artery and injection contract dye to create digital subtraction images of extra and intracranial blood vessels
8
Q
Acute Treatment of Stroke
A
-treat with IV tPA if <8 hr from symptom onset & patient meets other strict criteria
9
Q
Stroke Prophylactic Treatment
A
- vascular stenting or endarterectomy for stenosis >70% of lumen diameter
- anti-hypertensive Rx
- Anti-lipid Rx
- Anti-platelets Rx for atherothrombotic stroke
- Anti-coagulants only for cardioembolic stroke
- Anti-diabetic Rx
- Stop smoking
- Physical exercise
