*strokes* Flashcards
What is a cerebrovascular accident?
obstruction or rupture of an artery in the brain!!
What are the two types of risk factors in terms of why we have intracranial hemorrhage?
non modifiable
modifiable
What are modifiable risk factors?
High blood pressure
High cholesterol (lipid medications)
Cigarette smoking (Birth control >35 yrs old + smoking= higher risk)
TIA
Heart disease
Diabetes mellitus
Non-modifiable risk factors?
Age
Gender
Race
Prior stroke
Hereditary (high cholesterol)
Hypercoagulopathy (blood clot easily- autoimmune diseases)
High RBC and sickle cell anemia
What is the circle of willis???
collateral blood flow
- scalp vessels, vessels of the dura and arachnoid
What does occlusion of the circle of willis result in?
infarct and ischemia
What is cerebral blood flow?
auto regulation of the cerebral vessels
How is perfusion in the arteries regulated? By what two things?
Oxygen and glucose
Ischemia and acidosis are VASO_____!!
dilators
What are the types of strokes?
ischemic and hemorrhagic
What are ischemic strokes?
occlusion of an artery from plaque buildup (high cholesterol- greasy food)
embolus causing sudden obstruction
(thrombi may break off)
S/S of an ischemic stroke?
Hemiparesis or Hemiplegia (contralateral)
Numbness (contralateral) and facial drooping
Aphasia (unable to speak)
Confusion or coma
Convulsions
Incontinence
Diplopia (double vision)
Dysarthria (slurred speech)
Headache, dizziness
What is a thrombus?
blood clot
What is an embolus?
obstruction of blood flow due to a mass of undissolved matter lodging in a vessel
What are hemorrhagic strokes?
blood vessel of the brain has BLOWN
Which is more fatal ischemic or hemorrhagic strokes?
HEMORRHAGIC!!
- rapidly fatal cannot go in and stop bleeding
- less common
What is a cerebral embolus?
occlusion of an intracranial vessel from a fragment of a foreign substance
What are some causes of cerebral embolus?
atherosclerotic plaque
GAFT
gas embolus- diving injuries
air embolism- after thoracic surgery
fat embolism- after long bone injuries
thrombi- valvular heart disease and A FIB
What are causes of hemorrhagic strokes?
cerebral aneurysms
AV (arterial venous) malformations
hypertension
stress/ exertion
cocaine or other sympathomimetic drugs
What are s/s of hemorrhagic strokes?
sudden onset accompanied by headache, nausea, vomiting, and quick deterioration
What does TIA stand for?
transient ischemic attacks
What IS a TIA?
focal cerebral dysfunction- temporary reduction in blood flow!
How long to TIA’s typically last?
mins-hours
rarely lasts more than 1-2 hours
recovery in 24 hrs
pt returns to normal
What are s/s of TIA’s?
Related to location of ischemia
Weakness
Paralysis
Numbness of the face
Speech disturbances
Result from a vascular disturbance
What are specific assessments we can do for these patients?
Facial droop (get them to smile)
Leg weakness / drift
Arm weakness / drift
Slurred speech, inappropriate words or mute “is this the way they normally talk”
Pupils
What are the contraindications of acute stoke bypass protocol??
CTAS 1
Symptoms resolved prior to medic arrives
Blood sugar <3mmol/L
Seizure at onset of symptoms
GS<10
Terminally ill or palliative care pt
Duration of transport to stroke hospital exceeds 2 hours
Pt must be presenting with ALL of the following in order to bypass to stroke centre…..
present NEW onset with one of the following:
- unilateral arm/leg weakness or drift
- slurred speech or inappropriate words or mute
- unilateral facial droop
time to arrive is within 6 hours of clearly determined time of onset of symptoms
perform LAMS - inform dispatch to aid in destination
Assessment and treatment for STROKES:
- Airway assessment and breathing
- History
Previous disorders (high cholesterol,
diabetes) - Medications (ace inhibitors, blood thinners,
etc) - Initial symptoms and progression
- Precipitating factors
- Muscle tone and sensation
LAMS score- Los Angeles Motor Score
Recognizes large vessel occlusion
Management of CVA’s:
Management
Airway
Suctioning and positioning
Breathing
IPPV, oxygenation
Circulation
Monitor BP and ECG
I.V. (start IV in unaffected side)
Positioning – supine with head elevated 15 degrees= airway protection
Protect extremities, careful transport, comfort and reassurance
Communicate with family!!!
