Stroke Treatment Flashcards
Why are stroke units important?
Well established evidence that patients do better 10 years after their admission.
Why is it important to mobilise the patient ASAP?
The probability of returning home decreases 20% for each day the patient is not mobilised.
What are the modifiable risk factors for stroke?
High BP, atrial fibrilliation (common in population over 70) - L atrium dilated and not contracting properly so easy for bits to break off (emboli), cocaine use and diabetes.
What are the non-modifiable risk factors for stroke?
Age, race (far asian more at risk of intracerebral stenosis), family history.
What is stroke prevalence like in the genders?
Better in woman until after menopause (most men die of other causes after 70 where more strokes in woman than men).
What investigations would you do on a suspected stroke patient?
Blood tests - full blood count (platelets, red cells), lipids, ESR - making blood too thick?
ECG/ 24 hr ECG
What imaging may be useful in diagnosing a stroke?
Most patients will get a CT scan
Some get MRI
Carotid doppler to look at vessels for atheroma or dissection
Sometimes an echocargiogram (US of heart) can be helpful to look for clots in the heart
Discuss CT vs MRI.
CT (uses Xray) - quick, shows up blood MRI scan (uses magnet) - takes 30 mins, claustrophobic, shows up ischaemic stroke better than CT does
If you are wanting to know if it is an ischaemic stroke or haemorrhage what is the best imaging technique to use?
MRI.
What is the NIHSS?
A measure of the severity of stroke going from 0-32. 0 is a very mild stroke and 32 is the patient is barely alive.
How often to strokes happen in the UK?
152,000 strokes in the UK per year.
One every 5 mins.
Some people will cope very well and others (20%) die.
How much does stroke cost the UK per year?
ten billion pounds.
What kinds of things do you want to concentrate on helping patients do (to mobilise)?
Swallowing, positioning etc - prevent patient developing an aspiration pneumonia.
How many stroke patients will have swallowing problems and how do you deal with this?
50%
Concentrating on expertise and using specialists working together, e.g. physio and speech therapists.
How would you treat thrombolysis?
Give thrombolytic agents or removal of clot to restore area of infarction.
Why is time brain?
Every minute in which a large vessel ischaemic stroke is untreated the average patient loses 1.9 mil neurones, 13.8 bill synapses, 12km axonal fibres.
What is the aim of thrombolytic agents or therapy?
To restore perfusion before cell necrosis occurs.
How can you harm someone with a stroke?
Altepase - fibrinolytic agent.
Cause unexpected bleeding in the brain if tissue has established bleeding.
If brain tissue already dead not going to help supplying blood.
Bleeding else where e.g. GI tract.
What are the risk factors for haemorrhage after thrombolysis?
Infarct size, vessel occlusion, diabetes, BP, age, stroke severity, tissue changes and anti platelets (aspirin/clopidogrel).
Should streptokinase be used for the patients in the treatment of acute phase stroke?
No, increased risk of bleeding, and anaphylaxis because produced by mycobacterium.
After how many hours is it not worthing giving thrombolysis as the risk of haemorrhage outweigh the benefits?
4 and half.
After how many hours is it not worthing giving alteplast as the risk of haemorrhage outweigh the benefits?
4 and half.
What are the practicalities of FAST treatment?
Stroke symptom recognition Calling for help Altering hospital team Alterting CT/radiology team Keeping the patients/relatives informed
What is FAST?
Symptoms of stroke, advertised Face - falling to one side Arms - can't raise above head Speech - dysathria, dysphasia Time - time is brain
