Ischemic stroke early assessment: Difference between revisions

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Revision as of 19:21, 21 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

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.

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

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

Template:WS Template:WH

@@ Line 17: / Line 17: @@
 ) '''''Breathing'''''<br>
 ) '''''Circulation''''' |A02=
-) '''''O2 administration at SpO2<94%'''''
+'''1)''' O2 administration at SpO2<94%
-) '''''Ventilatory assisstance is provided to patients who have difficulty breathting'''''
+'''2)''' Ventilatory assisstance is provided to patients who have difficulty breathting
-) '''''IV fluids or vasopressors are given to maintain hemodynamic stability'''''}}
+'''3)''' IV fluids or vasopressors are given to maintain hemodynamic stability}}
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-|B03='''Initial diagnostic tests''' }}
+'''1)''' Help assess the severity of neurological deficit
+'''2)''' Give clue to the underlying cause
+'''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 }}
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+r-tPA in eligible patients within 3-4.5 hours of onset of symptoms|C04='''''Surgical''''' }}
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