Hemorrhagic stroke resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
===Diagnosis=== | ===Diagnosis=== | ||
{{familytree/start}} | |||
{{familytree | | | | | | A01 | |A01='''Check vitals'''<br>'''Stabilize ABC'''<br>'''Brief Hx'''<br>'''Rapid physical exam''' - neuro exam, '''NIHSS'''<br>'''Activate stroke team'''<br>'''Stat fingerstick'''<br>'''Basic labs,''' troponin, EKG<br>'''NPO'''<br>'''Obtain stroke protocol'''}} | |||
{{familytree | | | | | | |!| | |}} | |||
{{familytree | | | | | | B01 | | | |B01=Non-contrast CT (or MRI)}} | |||
{{familytree | | | | | | |!| | | ||}} | |||
{{familytree | | | | | | C01 | | | |C01='''Bleed'''}} | |||
{{familytree | | | |,|-|-|^|-|-|.| | | |}} | |||
{{familytree | | | D01 | | | | D02 |-| D03 | | |D01=Positive|D02=Negative|D03=Ischemic Stroke}} | |||
{{familytree | |,|-|^|-|.| | | |!| | |}} | |||
{{familytree | E01 | | E02 | | E03 | | | |E01='''Intracerebral Hemorrhage'''|E02='''Subarachnoid Hemorrhage'''|E03=Strong Suspicion for SAH}} | |||
{{familytree | |!| | | |!| | | |!|}} | |||
{{familytree | F01 | | |!| | | F02 | | |F01=Management of ICH|F02=May consider lumber puncture}} | |||
{{familytree | | | | | |!| | | |!| | |}} | |||
{{familytree | | | | | G01 | | G02 | | | |G01=Management of SAH|G02=Xanthochromia or bloody CSF}} | |||
{{familytree | | | | | |!| |,|-|^|-|.| | | |}} | |||
{{familytree | | | | | |`| H01 | | H02 |-| H03 | | |H01=Yes|H02=No|H03='''No SAH'''}} | |||
{{familytree | | | | | | | | | | | |!| | |}} | |||
{{familytree | | | | | | | | | | | I01 | | |I01=Strong Suspicion for SAH}} | |||
{{familytree | | | | | | | | | | | |!| |}} | |||
{{familytree | | | | | | | | | | | J01 | |J01=Traumatic tap?<br>Poor Technique?}} | |||
{{familytree | | | | | | | | | |,|-|^|-|.| | |}} | |||
{{familytree | | | | | | | | | K01 | | K02 | |K01=Yes|K02=No}} | |||
{{familytree | | | | | | | | | |!| | | |!| | |}} | |||
{{familytree | | | | | | | | | L01 | | L02 | | | |L01=CTA/MRA<br>Consult to Neurosurgeon<br>Talk with superior|L02=Normal CSF}} | |||
{{familytree | | | | | | | | | | | | | |!| | |}} | |||
{{familytree | | | | | | | | | | | | | M01 | | | |M01=Obtain more Hx and Investigation<br>Rule out other causes<br>Analgesia}} | |||
{{familytree/end}} | |||
===Intracerebral Hemorrhage=== | ===Intracerebral Hemorrhage=== | ||
====Coagulopathy==== | ====Coagulopathy==== | ||
Revision as of 17:57, 11 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Definitions
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- All the causes of stroke are life-threatening.
Common Causes
- Hypertension
- Bleeding disorders
- Illicit drug use (e.g., amphetamines or cocaine)
- Trauma
- Vascular malformations
- Rupture of arterial aneurysms
Management
Diagnosis
| Check vitals Stabilize ABC Brief Hx Rapid physical exam - neuro exam, NIHSS Activate stroke team Stat fingerstick Basic labs, troponin, EKG NPO Obtain stroke protocol | |||||||||||||||||||||||||||||||||||||
| Non-contrast CT (or MRI) | |||||||||||||||||||||||||||||||||||||
| Bleed | |||||||||||||||||||||||||||||||||||||
| Positive | Negative | Ischemic Stroke | |||||||||||||||||||||||||||||||||||
| Intracerebral Hemorrhage | Subarachnoid Hemorrhage | Strong Suspicion for SAH | |||||||||||||||||||||||||||||||||||
| Management of ICH | May consider lumber puncture | ||||||||||||||||||||||||||||||||||||
| Management of SAH | Xanthochromia or bloody CSF | ||||||||||||||||||||||||||||||||||||
| Yes | No | No SAH | |||||||||||||||||||||||||||||||||||
| Strong Suspicion for SAH | |||||||||||||||||||||||||||||||||||||
| Traumatic tap? Poor Technique? | |||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||
| CTA/MRA Consult to Neurosurgeon Talk with superior | Normal CSF | ||||||||||||||||||||||||||||||||||||
| Obtain more Hx and Investigation Rule out other causes Analgesia | |||||||||||||||||||||||||||||||||||||