Stroke resident survival guide

Stroke Main page
Patient Information
Overview
Causes
Classification Hemorrhagic stroke Ischemic stroke
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Diagnosis NIH stroke scale Glasgow coma scale
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
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Surgery
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Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Management

Evaluation Goal: Evaluation done within 60 mins of patient's arrival Check vitals ABCs Rapid Hx - time of onset, time of arrival at the ED, medications (especially anticoagulants) Rapid physical exam - neuro exam, NIHSS Activate stroke team Stat fingerstick Labs EKG, troponin, CXR NPO Obtain stroke protocol

Rule out DD Seizure, syncope, migraine, hypoglycemia

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Non-contrast enhanced CT (or MRI) to r/o hemorrhage

Bleed positive

Hemorrhagic stroke

Bleed negative

Hemorrhagic stroke algorithm

Acute ischemic stroke

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Time of onset

<3 hours

3 -4.5 hours

>4.5 hours

Eligibility criteria for IV rTPA

Consider rTPA after excluding patients >80 years old, those taking anticoagulants regardless of INR, baseline NIHSS >25, those with imaging evidence of ischemic injury involving >1/3 of the MCA territory, or those with a history of both stroke and diabetes mellitus

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Eligible

Not eligible

Blood pressure control algorithm Treat fever with IV antipyretics

BP≤180/110

BP≥180/110

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IV rTPA 0.9 mg/kg (maximum of 90 mg) with 10% given as intravenous bolus over 1 minute and the rest as IV infusion over 1 hour

Commence IV antihypertensives

Admit ICU for BP monitoring + bleeding complications Vitals Neurocheck hourly Aspiration precautions

After 24 hours post rTPA or no rTPA

Follow-up head CT/MRI before commencing antiplatelets

ASA 325 mg (if no contraindication) Statins DVT prophylaxis

PTOT evaluation Speech and swallow evaluation

Investigate the cause MRA/CTA/carotid duplex Venous doppler USS Echocardiography