stroke
-abrupt-onset focal neurologic deficit that lasts at least 24 hours and is of
presumed vascular origin
b
Which lasts at least 24 hours?
a) TIA
b) stroke
a
Which lasts < 24 hours, usually less than 30 min?
a) TIA
b) stroke
false
Strokes are more prevalent in men. T/F?
b
Which is more lethal?
a) ischemic
b) hemorrhagic
sudden: weakness on one side, trouble walking, vision problems, speaking problems, severe headache
Signs of a stroke? (5)
face uneven, arm drift down, strange speech, time
What does the acronym FAST stand for?
symptom onset > 4.5 hours/unknown, intracranial hemorrhage, severe head trauma/spinal surgery within 3 months, GI bleed <= 21 days, use of LMWH <=24 hrs, DOAC use <= 48 hours, infective endocarditis, aortic dissection, brain cancer
CI of Fibrinolytics in AIS treatment? (9)
platelets <100,000, INR > 1.7, aPTT >40s, PT> 15s
What CBC values are contraindicated in AIS treatment with fibrinolytics? (4)
cryoprecipitate, tranexamic, aminocaproic
What reversal agents can we use if we have an Intracranial bleed when
using fibrinolytic? (3)
<180/105 for at least 24 hrs
AIS-Supportive care: goal BP?
140-180 mg/dL
AIS-Supportive care: glucose goal?
O2> 94%
AIS-Supportive care: oxygen goal?
oxygen, anti-fever, BG, BP, DVT prophylaxis
What is included in AIS supportive care? (6)
>185/110; labetalol IV push, nicardipine IV, clevidipine IV
When administering a tPA, if the BP is __________; administer _______, ________, ________
slowly; 15%
If tPA NOT administered & BP >220/120 mmHg treat _______ with goal of
lowering _____ within the first 24 hours.
24-48 hrs after tPA; prevent conversion to hemorrhagic stroke
When/Why do we use Anti-Platelets in acute management of ischemic
strokes?
ASA 50-325 mg, ASA 25 mg + dipyridamole ER 200mg, Clopidogrel 75mg
What are our anti-platelets used post-stroke?
Warfarin/DOACs; 2-14 days post stroke
What medications do we use in secondary prevention if a patient has
AFIB/Flutter?
When does their treatment start?
anti-thrombotics, high-intensity statin, thiazide, ACEi/ARB
What are the treatments for secondary prevention of Ischemic stroke? (4)
weight management, physical activity, low-salt diet, smoking cessation, reduce alcohol
What is included in lifestyle counseling? (5)
ASA + dipyridamole
Aggrenox =
vasodilator; platelet inhibitor
Dipyridamole is a ______ and ________.
headaches
What is the most common AE in Aggrenox?
fixed dose of 25 mg ASA + 200mg dipyridamole ER, BID dosing, avoid if CrCl < 10mL/min, do not break/crush capsule
What are the dosing guidelines for Aggrenox? (4)
efficacious; ADEs
Aggrenox is more ________ than ASA monotherapy, but has higher rates of _______.
true
Aggrenox is equal to Clopidogrel in efficacy, but has worse tolerance. T/F?
cryptogenic
30% of strokes are _________.
cardioembolic
occurs when the heart pumps unwanted materials into the brain
circulation, resulting in the occlusion of a brain blood vessel and
damage to the brain tissue
atherosclerosis, cardioembolic, local thrombus formation
How do Ischemic strokes occur? (3)
ATP; anaerobic metabolism; lysis
Ischemia leads to ________ depletion and ________. Eventually leading to
cell _______.
glutamate; aspartate
__________ & _________ are released from ischemic tissue to perpetuate
damage.
African Americans, asian-pacific islanders, hispanics
Which races have higher risks of stroke? (3)
men; women
_______ have a higher rate at younger age, but ______ have higher mortality
& lifetime risk.
within 20 min of ER arrival
When should a stroke patient receive a CT scan?
glucose; coagulation tests
Once stroke is confirmed, what tests are done? (2)
within 4.5 hours
When are fibrinolytics given to stroke patients?
within 6 hours
When is a mechanical thrombectomy performed?
internal carotid artery; middle cerebral artery
Thrombectomies are indicated for patients with occlusion in the ______ or _______.
carotid stenosis
Carotid endarterectomy/stents are useful in secondary prevention if __________.
0.9 mg/kg over 60 min with 10% given as bolus over 1 min
Alteplace infusion?
monitor patient for severe HA, HTN, nausea/vomiting; stop infusion
Monitoring for Fibrinolytics? (3)
What do we do if patient has these signs?
measure BP every 15 min for 2hrs; ever 30 min for 6; every hr for 16
How does BP monitoring work Post-tPA?