stroke tutorial 1 Flashcards
what mnemonic do u use for ED history taking for stroke?
AMPLE
Allergy, medications, past med and surgical hx, last meal, events/ environment.
what is the maximum dosage for IV rTPA ?
90mg
what is the usual dosage for IV TPA?
0.9mg/kg
how do you administer IV tPA ?
10% of the first dose administered IV over 1 min
Remaining 90% to be delivered via infusion pump over 1 hr
how often should you monitor the vital signs after IV rtpa has been administered?
Vital signs every 15 mins for first 2 hrs and every 30 mins for 6 hrs and then hrly for 24 hrs; Keep systolic
<180 and Diastolic <105 mmHg (as per hospital guidelines)
what should you monitor for besides vital signs, after IV rtpa has been given?
On continuous cardiac monitoring & frequent neurologic assessment
how much should you maintain for the BP, after IV rtpa?
180/105mmHg
what is the side effect of IV rTPA?
bleeding
early signs of ICP increase
Headache
◦ Nausea and vomiting
◦ Confusion, irritability, restlessness
◦ Photophobia; diplopia is a late sign but can be an early sign in some cases.
late signs of ICP increase
`
Deterioration in LOC; GCS
◦ Changes in pupillary size, shape and
responsiveness to light
◦ Increase systolic BP, widening pulse pressure,
bradycardia and irregular respiration
◦ Decorticate & decerebrate posturing; flaccid
(end stage
what is the optimal CPP?
<60mmhg
what is the formula for CPP?
MAP-ICP= CPP
what are the side effects of IV mannitol
?
fluid, electrolytes imbalance, hyponatremia, hypotension, Pulmonary edema, cardiac heart failure
how much serum osmolality should you maintain for IV mannitol
320mmosm
how to control the cerebral metabolism?
reduce the need for oxygen and glucose by administering sedative, analgesic & neuromuscular blocker agents
– prophylactic antiepileptic & antibiotics
