stroke treatment Flashcards
what is thee preferred stroke assessment tool ?
NIHSS
ICH what is the best imaging modality ?
non contrast CT or MRI
what is a wake up stroke ?
an ischemic stroke associated with the onset of neurological symptoms upon waking up
what test must bee done before the administration of IV ateplase ?
blood glucose levels
what is the BP goal before the administration of ateplase ?
dont lower unless exceeding 220/120 , in that case lower by 15% and maintain it above 1880/110
how should BP be lowered before ateplase administration ?
labetalol or niardipinee
if there is resistant hypertension what should b used ?
IV sodium nitroprusside
how often should the BP be monitored ?
every 15 minutes for 2 hours after starting treatment
every 30 minutes for 6 hours for 16 hours
what is the dose of aletplasee used ?
0.9 mg over 60 minutes
what precautions must be taken when dealing with cerebral micro bleeds and ateplase ?
more than 10 micro bleeds then avoid ateplase
what other drugs should b avoid with ateplase ?
avoid abciximiab with it
a patient treated with LMWH in the past 24 hours
no aspirin within 90 minutes
when are antithrombotics given in relation to ateplase ?
24 hours after infusion
what substitution can be used for patients undergoing mechanical thrombolectomy ?
tenecteplase
alternative of altplase for minor symptoms ?
iv bolus tenecteplase
what are the indications for mechanical thrombolectomy ?
premodified rankin scale of 0 to 1
above 18 years old
NIHSS score 6 or higher
ASPECTS 6 or higher
what should be done for secondary stroke prevention ?
dual anti platelet therapy ( aspirin and clopidogrel ) within 24 hours of a minor stroke
not anti coagulants
avoid triple anti platelet therapy
what is the recommend treatment for high risk patients for treatment of hyperlipidemia ?
maximum dose tolerated of statins combined with ezetimibe
what are the post stroke complications ?
acute reperfusion injury
symptomatic intracranial haemorrhage
malignant cerebral oedema
infection
venous thromboembolism
dysphagia and nutritional consideration
what is the clinical picture of acute reperfusion injury ?
orolingual angioedema
what is the treatment for acute reperfusion injury
stop the transfusion then give anti histamines, iv corticosteroids, epinephrine and intubate the patient
what is thee treatment for symptomatic intracranial haemorrhage ?
cryopercipitatee
IV tranexeemic acid.
IVv aminocarpoic aciid
what is the best treatment for malignant cerebral oedema ?
surgical decompression with DHC
mannitol or HTS
when does VTE peak post stroke ?
day 2 to 7
how is early dysphasia screening done post stroke ?
water swallowing test
how is short term vs long term feeding achieved post stroke ?
short term : nasogastric tube
long term : percutaneous endoscopic gastrostomy tube
what is thee most common cause of fever in the first 48 hours after an acute stroke ?
pneumonia
what effect on breathing do bihemispheric strokes have ?
chayne-strokes respiration
what anti depressant can be used post stroke ?
fluoxetine
what are the most common causes of haemorrhagic stroke ?
AVM
hypertension
aneurysm
when can wee opt for non surgical treatment of haemorrhagic stroke ?
if the ICH volume is less than 10
what are the indications for surgery in haemorrhagic stroke ?
cerbellar hge more than 3 cms
young patients with lobar haemorrhage
