Stroke resident survival guide: Difference between revisions
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{{familytree | | | | G01 | | | | | |G01=<div style="float: left; text-align: left; line-height: 150% ">'''Consider alternative diagnosis:''' <br> ❑ Psychogenic <br> ❑ [[Seizures]] <br> ❑ [[Hypoglycemia]]<br> ❑ Complicated migraine<br> ❑ [[Encephalopathy|Hypertensive encephalopathy]]<br> ❑ [[Wernicke encephalopathy]]<br> ❑ [[Brain abscess]]<br> ❑ [[Brain tumor]]<br> ❑ Drug toxicity</div>}} | {{familytree | | | | G01 | | | | | |G01=<div style="float: left; text-align: left; line-height: 150% ">'''Consider alternative diagnosis:''' <br> ❑ Psychogenic <br> ❑ [[Seizures]] <br> ❑ [[Hypoglycemia]]<br> ❑ Complicated migraine<br> ❑ [[Encephalopathy|Hypertensive encephalopathy]]<br> ❑ [[Wernicke encephalopathy]]<br> ❑ [[Brain abscess]]<br> ❑ [[Brain tumor]]<br> ❑ Drug toxicity</div>}} | ||
{{familytree | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | A01 | | | {{familytree | | | | A01 |-| A02 | | | | | |A01=<div style="float: left; text-align: left; height: 10em; width: 20em; padding:1em;"> ❑ Check vitals<br> ❑ Stabilize ABC<br> ❑ Brief Hx<br>❑ Activate stroke team<br> ❑ Stat fingerstick<br> ❑ '''Labs''' - CBC, serum electrolytes, urea, creatinine, troponin, EKG, PT/PTT/INR<br> ❑ NPO<br> ❑ Obtain stroke protocol</div>|A02=<div style="float: left; text-align: left; height: 25em; width: 20em; padding:1em;">'''Other labs in selected patients:'''<br>❑ Liver function tests<br> ❑ Toxicology screen (drug abuse, stroke in the young)<br> ❑ Blood alcohol level<br>❑ Arterial blood gas (hypoxia)<br> ❑ Chest radiograph (lung disease)<br> ❑ EEG (seizures)<br> ❑ Lumbar puncture (SAH)<br> ❑ Sepsis profile - urinalysis, blood culture (if fever is present)<br> ❑ Type and cross match FFP (coagulopathy)<br> ❑ Pregnancy test (in women of child-bearing age)</div>}} | ||
{{familytree | | | | |!|}} | {{familytree | | | | |!|}} | ||
{{familytree | | | | B01 | | | | | | | | |B01='''Non-Contrast Enhanced CT''' (or MRI) to r/o hemorrhage}} | {{familytree | | | | B01 | | | | | | | | |B01='''Non-Contrast Enhanced CT''' (or MRI) to r/o hemorrhage}} | ||
Revision as of 18:22, 7 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Ayokunle Olubaniyi, M.B,B.S [3]
Overview
The term 'stroke' is used to describe pathological conditions caused by brain ischemia or hemorrhage. According to the American Heart Association/American Stroke Association (July, 2013),[1] it is defined as a neurological deficit attributed to an acute focal injury of the central nervous system (CNS) by a vascular cause, including cerebral infarction, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Therefore, by definition, trauma has to be ruled out before stroke can be diagnosed in a patient with a focal neurological deficit.
Management
Initial Evaluation
Characterize the symptoms: ❑ Sudden weakness/paralysis - face, arm or leg ❑ Speech/visual difficulties ❑ Altered/loss of consciousness ❑ Sudden severe headache | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ Head - trauma, tongue laceration ❑ Neck - bruits, pulses ❑ Limbs - pulses ❑ Heart - murmurs ❑ Skin - color changes ❑ Neurological exam, NIHSS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider alternative diagnosis: ❑ Psychogenic ❑ Seizures ❑ Hypoglycemia ❑ Complicated migraine ❑ Hypertensive encephalopathy ❑ Wernicke encephalopathy ❑ Brain abscess ❑ Brain tumor ❑ Drug toxicity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Check vitals ❑ Stabilize ABC ❑ Brief Hx ❑ Activate stroke team ❑ Stat fingerstick ❑ Labs - CBC, serum electrolytes, urea, creatinine, troponin, EKG, PT/PTT/INR ❑ NPO ❑ Obtain stroke protocol | Other labs in selected patients: ❑ Liver function tests ❑ Toxicology screen (drug abuse, stroke in the young) ❑ Blood alcohol level ❑ Arterial blood gas (hypoxia) ❑ Chest radiograph (lung disease) ❑ EEG (seizures) ❑ Lumbar puncture (SAH) ❑ Sepsis profile - urinalysis, blood culture (if fever is present) ❑ Type and cross match FFP (coagulopathy) ❑ Pregnancy test (in women of child-bearing age) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Contrast Enhanced CT (or MRI) to r/o hemorrhage | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleed Negative | Bleed Positive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute Ischemic Stroke | Hemorrhagic Stroke | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intracerebral Hemorrhage | Subarachnoid Hemorrhage | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Sacco, RL.; Kasner, SE.; Broderick, JP.; Caplan, LR.; Connors, JJ.; Culebras, A.; Elkind, MS.; George, MG.; Hamdan, AD. (2013). "An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (7): 2064–89. doi:10.1161/STR.0b013e318296aeca. PMID 23652265. Unknown parameter
|month=ignored (help)