Stroke part 2 Flashcards
Symptoms of Stroke
The patient may complain of:
Weakness on one side of the body=hemiparesis
Inability to speak=asphasia
Loss of vision
Vertigo, and/or falling
Ischemic stroke is not usually painful, but some patients may complain of headache.
Pain and headache, often severe, are more common with hemorrhagic stroke
BE-FAST
B=balance
E=eyes
F=face
A=arm
S=speech
T=time
The specific areas of neurologic deficit are determined by the area of the brain involved
Acute stroke assessment to determine treatment eligibility includes:
Blood ___________
___________count
Coagulation parameters (e.g., prothrombin time, aPTT)
Tests for hypercoagulable states (protein C/S deficiency, antiphospholipid antibody) should be done only when the cause of the stroke cannot be determined based on the presence of well-known risk factors
glucose
platelet
CT scan of the head will reveal an area of hyperdensity (bright) in patients with hemorrhage and will be normal or hypodense (dark) in patients with infarction
It may take 24 hours before the CT scan will reveal the area of infarction
MRI of the head will reveal areas of ischemia with higher resolution, and an MRI with diffusion-weighted imaging (DWI) will reveal an evolving infarct within minutes of stroke onset
Vascular imaging with CTA is recommended in patients with endovascular treatment indications
CTA can identify both acute treatment candidacy as well as identify intracranial and extracranial arterial stenosis
An ECG can help determine whether the patient is presenting with atrial fibrillation
TTE can identify cardiac valve abnormalities or wall-motion abnormalities as sources of emboli to the brain
A “bubble study” in which a solution with tiny bubbles is injected intravenously can be done to look for an intraarterial shunt indicating an atrial-septal defect or a patent foramen ovale
The bubbles can be seen moving through the heart chambers during the TTE
In patients unable to undergo CTA, carotid Doppler (CD) and transcranial Doppler (TCD) can be used to determine extracranial carotid artery stenosis and intracranial artery stenosis
Patient Assessment
Hemodynamic stability
tPa candidates
Systolic blood pressure [SBP] < ______mm Hg
Diastolic blood pressure [DBP] < 110 mm Hg
Non-tPa candidates
BP less than 220/120 mm Hg
O2 sat >94% [0.94]
temperature <38°C (100.4°F)
Blood glucose (<60 mg/dL [3.7 mmol/L] or >180 mg/dL [10.0 mmol/L] should be treated)
Presence of active bleeding and/or bleeding risk factors
Patient’s candidacy for tissue plasminogen activator treatment or thrombectomy
Presence of dysphagia
<185
Pharmacologic Options for Blood Pressure Lowering in Acute Stroke
10-20 mg IV over 1-2 minutes; may repeat
5 mg/hr, titrate up by 2.5 mg/hr every 5-15 minutes, maximum 15 mg/hr
Labetalol
Nicardipine
Pharmacologic Thrombolytics for Ischemic Stroke
___________0.9 mg/kg IV (maximum 90 mg), 10% as a bolus with the remainder given over 1 hour
___________0.25 mg/kg IV bolus (maximum 25 mg)
Door to needle time ≤ 60 minutes
Thrombolytics must be administered within 4.5 hours of symptom onset
Alteplase
Tenecteplase
Aspirin within 24 to 48 hours unless contraindicated; delay for 24 hours if the patient has been given tissue plasminogen activator
Antiplatelet drug therapy regimen including specific medication(s), dose, frequency, and duration OR oral anticoagulant, if the patient has atrial fibrillation
Evaluation for carotid endarterectomy or carotid stenting
Prophylaxis for venous thromboembolism, if immobile
Nutritional plan; if the patient has dysphagia, nutrition via nasogastric tube or percutaneous gastrostomy tube
Treat and manage stroke risk factors
