stroke therapy Flashcards
what are the investigations to carry out for stroke?`
blood tests - FBC (platelers, RBC, WCC) lipids, ECG/24 hrs ECG CT MRI scan (less often than CT) carotid doppler to look at vessels echocardiogram (some times useful)
what us an echocardiogram useful for when investigating a stroke?
clots in the heart
what are the advantages of CT over MRI?
quick
shows up blood
what are the advantages of MRI scan over CT?
long (up to 30 mins)
claustrophobic
shows ischaemia better than CT
what is the most important thing to do in order to increase survival before treatment is started?
get patient to stroke unit
what are the advantages of stroke unit over a more general ward?
-patients do better up to 10 years after admission
as:
-mobilided ASAP
-simples things like swallowing and positioning are concentrated on
-early therapy
-expertise is concentrated
what is the a common respiratory complication of many strokes?
aspiration pneumonia
how many neurons are lost every minute a large vessel ischaemic stroke is untreated?
1.9 million
what is the aim of thrombolysis in the treatment of strokes?
to restore perfusion before cell death occurs (salvage penumbra)
what is a high platelet count indicative of in stroke?
haemorrhage
which type of stroke patients are more likely to aspirate?
patients with haemmorhage
when is thrombolysis treatment given for strokes?
3-4.5 hours after event
what are the risks of thrombolysis?
haemorrhage
what are the risk factors for haemorrhage after thrombolysis treatment of stroke?
infarct size vessel occlusion diabetes BP age stroke severity tissue changes antiplatelets
what can be done to speed up the process of reviewing, investigating and treatment a stroke patient once they have made it to hospital?
pre-hospital notification (by ambulance)
what are the interventional treatments for stroke?
endovascular thrombectomy
what kind of strokes are treated with thrombectomy and IVT?
large vessel occlusion stroke
which drug is used in the thrombolysis of clots in strokes?
recombinant tissue plasminogen activator (rTPA)
alteplase
what are the contraindications to thrombolysis?
age
licence
over 80s
MI with recent bleeding or very high bp
what treatment is given ti under 60s with middle cerebral artery stroke and massive cerebral oedema?
hemicraniectomy
what other medication is often given along with rTPA?
aspirin
which patients are most at risk of a secondary stroke?
patients with a past stroke
what are the secondary prevention techniques for stroke patients?
-antiplatelets
clopidogrel 75mg
or
aspirin 75mg plus dipyridamole MR 200mg bd
-statin
-antihypertensive drugs (even if bp normal)
what is a carotid endarterectomy?
operation carried out to remove atheromatous plaque from carotid artery to reduce the risk of stroke
