Ischemic stroke early assessment: Difference between revisions

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Latest revision as of 17:50, 30 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

The early assessment of stroke includes airway, breathing and circulation assessment even befor the patient is transferred to the stroke unit or hospital. Once patient is hemodynamically stable, further management is directed towards determining the underlying cause and appropriate treatment plan.^[1]

Early assessment

The initial assesment goals of ischemic stroke may include the following. ^[1]

1) Airway

2) Breathing

3) Circulation

1) O2 administration at SpO2<94%

2) Ventilatory assisstance is provided to patients who have difficulty breathting

3) IV fluids or vasopressors are given to maintain hemodynamic stability

Early Diagnosis

History and PE

1) Help assess the severity of neurological deficit
2) Give clue to the underlying cause

3) Determine the site of infarction

Initial diagnostic tests

1) Noncontrast brain CT or brain MRI
2) Blood glucose
3) Oxygen saturation
4) Serum electrolytes/renal function tests
5) Complete blood count, including platelet count
6) Markers of cardiac ischemia
7) Prothrombin time/INR
8) Activated partial thromboplastin time

9) ECG

Early assessment of ischemic stroke

Reperfusion therapy

Medical
r-tPA in eligible patients within 3-4.5 hours of onset of symptoms

Surgical

Symptomatic relief

1) Fever
2) Headache
3) Shortness of breath

Prognosis

1)NIHSS scoring
2)Glassgow coma scale

References

↑ ^1.0 ^1.1 Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.

Template:WS Template:WH

[pmid23370205-1] 1.0 ^1.1 Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.

[1]

@@ Line 5: / Line 5: @@
 ==Overview==
-Early recognition of the signs of stroke is generally regarded as important. Only detailed [[physical examination]] and [[medical imaging]] provide information on the presence, type, and extent of stroke, and hence hospital attendance — even if the symptoms were brief — is advised.
+The early assessment of stroke includes airway, breathing and circulation assessment even befor the patient is  transferred to the stroke unit or hospital. Once patient is hemodynamically stable, further management is directed towards determining the underlying cause and appropriate treatment plan.<ref name="pmid23370205">{{cite journal| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. | journal=Stroke | year= 2013 | volume= 44 | issue= 3 | pages= 870-947 | pmid=23370205 | doi=10.1161/STR.0b013e318284056a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205  }} </ref>
-Studies show that patients treated in hospitals with a dedicated Stroke Team or Stroke Unit and a specialized care program for stroke patients have improved odds of recovery.
 ==Early assessment==
-===Goal of initial assesment===
+The initial assesment goals of ischemic stroke may include the following. <ref name="pmid23370205">{{cite journal| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. | journal=Stroke | year= 2013 | volume= 44 | issue= 3 | pages= 870-947 | pmid=23370205 | doi=10.1161/STR.0b013e318284056a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205  }} </ref>
-{{familytree/start |summary=PE diagnosis Algorithm.}}
+<small>{{familytree/start |summary=PE diagnosis Algorithm.}}
 {{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=
-'''''Airway'''''<br>
+) '''''Airway'''''<br>
-'''''Breathing'''''<br>
+) '''''Breathing'''''<br>
-'''''Circulation''''' |A02=AO2 }}
+) '''''Circulation''''' |A02=
+'''1)''' O2 administration at SpO2<94%
+'''2)''' Ventilatory assisstance is provided to patients who have difficulty breathting
+'''3)''' IV fluids or vasopressors are given to maintain hemodynamic stability}}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |)|-| B01 |-| B02 |-| B03 | | | |B01=
 '''''Early Diagnosis''''' |B02=
-'''History and PE'''<br>
+'''''History and PE'''''
-|B03='''Initial diagnostic tests''' }}
+'''1)''' Help assess the severity of neurological deficit<br>
+'''2)''' Give clue to the underlying cause<br>
+'''3)''' Determine the site of infarction <br>
+|B03='''''Initial diagnostic tests'''''
+'''1)''' Noncontrast brain CT or brain MRI<br>
+'''2)''' Blood glucose<br>
+'''3)''' Oxygen saturation<br>
+'''4)''' Serum electrolytes/renal function tests<br>
+'''5)''' Complete blood count, including platelet count<br>
+'''6)''' Markers of cardiac ischemia<br>
+'''7)''' Prothrombin time/INR<br>
+'''8)''' Activated partial thromboplastin time<br>
+'''9)''' ECG }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 |-| C04 | | |C01='''Early assessment of ischemic stroke''' |C02='''Treatment plan''' |C03='''Medical'''|C04=Surgical }}
+{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 |-| C04 | | |C01='''Early assessment of ischemic stroke''' |C02='''''Reperfusion therapy''''' |C03='''''Medical'''''<br>
+r-tPA in eligible patients within 3-4.5 hours of onset of symptoms|C04='''''Surgical''''' }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01='''''Treatment of complications''''' |D02=Cerebral edema<br>Hyperglycemia<br>DVT<br>}}
+{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01='''''Symptomatic relief''''' |D02='''1)''' Fever<br>'''2)''' Headache<br>'''3)''' Shortness of breath<br>}}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01='''''Prognosis''''' |E02=NIHSS scoring }}
+{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01='''''Prognosis''''' |E02='''1)'''NIHSS scoring<br>
+'''2)'''Glassgow coma scale}}
-{{familytree/end}}
-'''Hemodynamic stability'''
+{{familytree/end}}<small>
-*Airway
-*Breathing
-*Circulation
-'''Symptomatic relief'''
-*Pain
-*Fever
-*Dehydration'''
-*Infection
-'''Early diagnosis and treatment plan'''
-*Non contrast CT or MRI
-*NIHSS Scoring/Glasgow coma scale
-*Antiplatelet therapy
-*Thrombolytic therapy
-*Mechanical thrombectomy
-'''Underlying cause assessment'''
-*Cardioembolism
-*Large artery atherosclerosis
-*Small vessel disease
-'''Prognosis'''<br>
-'''Maintainence therapy and secondary prevention'''
 ==References==

Ischemic stroke early assessment: Difference between revisions

Latest revision as of 17:50, 30 November 2016

Overview

Early assessment

References

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