TIA Flashcards
what is important to ask in the history of TIA part 1
START WITH OPEN ENDED QUESTIONS AND THEN GO FOR A CLOSED ENDED APPROACH OF QUESTION
onset of the TIA
how long the symptoms lasted
any exacerbating or reliving factors
how many times has he had these sort of symptoms
any change in concious level
WHAT WERE THE SYMPTOMS PRESENT
DOES HE HAVE ANY RESIDUAL SYMPTOMS - such as weakness or instability
ANY PRODROMAL OR WARNING SYMPTOMS
any palpitations
what is important to ask in the history of TIA part two
if he has diabetes - how complaint are he with his medications
and is it regularly monitored and controlled
same goes for his hypertension medications
any family history of stroke or cardiovascular and cerebrovascular disease or clotting
what is important to ask in the history of TIA part three
is he a smoker
his diet history
DOES HE DRIVE
Finally, I would complete a detailed systems review
With his IDEAS, concerns and expectations
investigation you would order for TIA ?
ECG
blood test, specifically asking for a full blood count, renal function, HbA1c !!!!(for diabetes), cholesterol profile
I would ask my consultant these before ordering
prolonged ECG monitoring,
an echocardiogram,
carotid ultrasound, and an MRI head
Many conditions (sometimes known as stroke mimics)
Hypoglycaemia and
Drug and alcohol toxicity.
hemiplegic migraines or migraines with aura
Central nervous system abscess.
Encephalitis.
space occupying lesions
subdural hematoma
Hypertensive encephalopathy.
tx ?
if suspecting stroke or TIA- give aspirin 300mg initially
then if TIA Refer the person for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms.
continue on clopidrogel75mg OD with PPI cover
GIVE ATORVASTATIN
high intensity statin should be initiated, such as atorvastatin 80mg OD. Cholesterol should be checked three months after initiating this to check the response to medication.
TARGET BP <reduce to a level below 140/90 mm Hg
and if possible and tolerable to 130/80 mm Hg or even lower
what advice should be given in TIA ?
begin by explaining to the patient what a TIA is. I would explain that a transient ischaemic attack (TIA) is often a herald of a stroke
advice to stop smoking - smoking cessation clinic if necessary
alcohol limited to less than 14 units a week
encouraging physical activity;
low salt, reduced intake of saturated fats.
Your investigations reveal a diagnosis of atrial fibrillation in the person with TIA . Would you start the patient on treatment?
Anticoagulation should be initiated in patients who present with TIA who are found to have persistent or paroxysmal atrial fibrillation. Treatment can start as soon as imaging has confirmed no presence of haemorrhage or factors that may be contraindicated
cha ds vasc score
1 for men
2 for women
use to ORBIT SCORE or HASBLED score
estimates the risk of major bleeding for patients on anticoagulation for atrial fibrillation (AF)
DOAC COUNSELLING ?
so the doc is usually taken once a day - if you miss a dose it ha a shot half life , take it when you remember during the day , however you should not have two doses in one day
DOAC do not need monitoring
if you do have any planned procedures or invasive procedures make sue to get medical advice based on when to stop this drug
alcohol does not interact with it however we do advice to keep the alcohol intake to minimum as possible
because this s blood thinning medications - make sure to avoid activities which can increase your risk of bleeding - such as contact sports
if in any instance you do find yourself to have nose bleeds , or excessive bruising or vomiting
PERSISTANT HEADACHE
TRAUMA TO THE HEAD
- make sure to see urgent medical advice and help and stop the drug
i WILL ALSO GIVE THE PATIENT A WRITTEN LEAFLET CONTAINING INFORMATION OF THE DRUG
refer to anticoagulation team
