Stroke

Question 0

Stroke classification

Answer 0

Ischaemic (3)
1. THROMBI. caused by 
       Arthersclerosis
       Vasculitis
       Polycythaemia (^ RBC)
       Infectious disease (meningitis, endocarditis) 

2. EMBOLI 
       Cardiogrnic emboli after, AMI, Atrial or Ventricular septal 
        Defects
        Fat emboli 
        Septic emboli 

3. HYPOPERFUSION
   Cardiac failure

Question 1

Define Stroke

Answer 1

An acute neurovascular injury secondary to cerebrovascular disease that is either ischaemic of haemorrhagic of cause.

Question 2

Initial management of stroke

Answer 2

STROKE management

1. Think FAST
2. Rapid Ax & identify pt eligible for thrombolysis
3. Ax Risk (ABCD score for risk)
4. Met call if pt has S & S

Airway - Ax - LOC

        - Nil orally
        - Intubate <8

Breathing - Ax WOB, RR, SaO2
- high flow O2 if below 95% pt v/s baseline to be considered

Circulation - Ax HR, Manual BP, cardiac rhythm
- manage hypotension aggressive Mx hypertension not recommend
CCP = MAP - ICP
2 x large cannulae
• FBE, U & E, LFT, COAG, BGL, Troponin
• IV fluids - PRN
Maintain euvolemia
• ECG
- check for AF or recent AMI
- T wave inversion common 75% of pt with acute stroke

Disability - Monitor GCS, pupil size, reactivity, 1/24hr
- BGL 2-4 24hr
- elevate head 30*
- nil orally until review
- urgent CT scan / MEI
- hypothemia ???
- anti-platelet therapy for ischaemic stroke
• Aspirin 150-300mg
REFERAL
• Speech therapy
• swallowing Ax
• mobility Ax
• discharge planning
Acute ischaemic stroke ~ urgent referral to neurology ~ thrombolysis