How do you manage a haemorrhaging stroke
Manage the blood pressure and AVOID statins
How to you manage an ischemic stroke stroke
Initial management with aspirin
-TIA: 300mg daily until diagnosis is established
- ischaemic stroke: 300mg for 14 days following alteplase (administered within 4.5 hours)
What is the long term management of treating an ischemic stroke
1st line: clopidogrel 75mg OD
2nd line: aspirin 75mg OD
Proton pump inhibitor
High intensity statin as soon as soon as they can swallow
Start high intensity statins 48 hours after stroke
Manage hypertension to achieve <130/80
(TLD, Calcium channel blocker, ar blocker, ace-i
What are the two main types of stroke
Ischemic stroke (more common) caused by a blockage 875)
- blood clots, fatty plaques diabetes smoking alcohol dyslipidemia hypertension
Hemorragic = rupture (13%)
Hypertension aneurysm blood thinners, head trauma brain tumours bleeding disorders
How to manage an ischemic stroke
Face- can they smile
Arm- can they raise both arms
Speech- can they speak clearly
Time- call 999
On admission used the rosier tool to diagnose stroke
Haemorrhage stroke
Remove haemotoma and relieve intercranial pressure
Stop anticoagulants
Rapid blood pressure lowering for people with acute inter cerebral haemorrhage.
With six hours of symptoms
Have systolic pressure of 150 to 220 MMHG
Do not get patience with structural cause, Glasgow coma scale score < 6 neurosurgery to evacuate the haematoma, very large haematoma with poor prognosis
Risk status has not been determined.
Considered benefit versus risk before initiating statin treatment
TIA
Initial treatment is aspirin 300mg
- if already on 75mg carry on no needs to be on the 300mg
Long term- same as stoke
If at high risk of TIA, before starting long term management offer:
Dual therapy with aspirin and clopidogrel (up to 90 days)
Dual therapy with aspirin and ticagrelor (up to 30 days)
