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    Acute Management of Stroke

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    BKGUBIO
    This document provides guidelines for the acute management of stroke. It outlines the importance of quickly treating and stabilizing the patient, performing diagnostic tests to determine the type of stroke, and considering thrombolysis for ischemic strokes within 4.5 hours if the patient meets criteria. Close monitoring of vital signs like blood pressure, glucose, temperature and fluids is also recommended to prevent complications and preserve brain tissue.

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    Acute Management of Stroke

    Uploaded by

    BKGUBIO
    12 views19 pages
    This document provides guidelines for the acute management of stroke. It outlines the importance of quickly treating and stabilizing the patient, performing diagnostic tests to determine the type of stroke, and considering thrombolysis for ischemic strokes within 4.5 hours if the patient meets criteria. Close monitoring of vital signs like blood pressure, glucose, temperature and fluids is also recommended to prevent complications and preserve brain tissue.

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    70478749 Acute Management of Stroke

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    This document provides guidelines for the acute management of stroke. It outlines the importance of quickly treating and stabilizing the patient, performing diagnostic tests to determine the type of stroke, and considering thrombolysis for ischemic strokes within 4.5 hours if the patient meets criteria. Close monitoring of vital signs like blood pressure, glucose, temperature and fluids is also recommended to prevent complications and preserve brain tissue.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    12 views19 pages

    Acute Management of Stroke

    Uploaded by

    BKGUBIO
    This document provides guidelines for the acute management of stroke. It outlines the importance of quickly treating and stabilizing the patient, performing diagnostic tests to determine the type of stroke, and considering thrombolysis for ischemic strokes within 4.5 hours if the patient meets criteria. Close monitoring of vital signs like blood pressure, glucose, temperature and fluids is also recommended to prevent complications and preserve brain tissue.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    Acute Management of Stroke

    Dr Amri Masri
    June 2011
    Race against time
    • Treatment and stabilisation of patient.
    • Specific therapy:
    – Recanalisation
    – Neuroprotection
    • Acute complications:
    – Secondary haemorrhage, oedema, seizures, aspiration,
    infections, ulcers, DVTs, PE.
    • Early secondary prevention.
    • Early rehabilitation.
    Penumbra
    Emergency diagnostic tests in acute stroke.

    • Brain imaging CT or MRI.


    • ECG.
    • FBC, Clotting profile.
    • Serum electrolytes.
    • Blood glucose.
    • Hepatic and renal parameters.
    • CRP or ESR.
    The decision:
    To thrombolyse or not…
    Ischaemic Stroke Thrombolysis

    • Inclusion:
    – Clinical diagnosis of ischaemic stroke with recognisable
    neurological deficits.
    – *Within 4.5hrs.
    – *Seizures at stroke onset but must be clear the seizure is
    due to cerebral ischaemia.
    – *Age 18-80 yrs.
    – *Haemorrhage excluded by CT.
    – Consent to treat.
    Ischaemic Stroke Thrombolysis

    • Exclusion:
    – Beyond 4.5hrs.
    – Severe neurological deficit NIHSS > 25.
    – Stroke within last 3 mths.
    – Traumatic brain injury last 3 mths.
    – MI last 3 mths.
    – GI/GU bleeding last 3 weeks.
    – Larger surgical interventions last 2 weeks.
    – Symptoms suggestive of SAH even if CT is normal.
    – Arterial puncture in non-compressible site.
    Ischaemic Stroke Thrombolysis

    • Exclusion(cont’):
    – Large stroke in CT >1/3 of hemisphere.
    – Intracerebral bleeding in history.
    – Diabetes and stroke in history.
    – On oral anticoagulation, INR must be <1.5.
    – Heparin in the last 48hrs, aPTT <40s, Platelets >100
    – Uncontrolled BP, must be <185/110
    – Dysglycaemia <3 or >22 mmol/L
    – Acute pancreatitis.
    – Endocarditis.
    rtPA- Actilyse

    • 0.9mg/kg, maximum dose of 90mg.


    • Give 10% of dose as bolus then the remaining as
    infusion over 1hr.
    Thrombolysis SOP
    • 2 large bore cannulas both antecubital veins before
    thrombolysis.
    • Catheterise before thrombolysis.
    • No invasive procedures, IM injections after thrombolysis.
    • No FH, LMWH, antiplatelets 24hrs after thrombolysis.
    • Beware of anaphylaxis, bleeding.
    • If headache, nausea, vomiting, acute BP increase stop
    thrombolysis and repeat CT.
    • 24hrs bed rest.
    • Repeat CT 24-48hrs after thrombolysis.
    Monitoring parameters: Airway and Respiratory

    • Airway protection.
    • Risk of aspiration.
    • Maintain adequate oxygenation for preservation of
    penumbra.
    • Continuous SpO2 monitoring at least 24-48hrs.
    Monitoring parameters: Cardiovascular

    • Continuous heart rate monitoring.


    • Prior HTN 180/100-105.
    • Without prior HTN 160-180/90-100.
    • Thrombolysed patient BP <185/110.
    • Avoid nifedipine SL and drastic BP reduction.
    • Immediate antihypertensive therapy in concomittant
    medical problems e.g. ICH, cardiac failure, ACS,
    aortic dissection, hypertensive encephalopathy.
    • Avoid and treat hypotension: fluids, volume
    expanders, catecholamines.
    Monitoring Parameters: Blood glucose

    • Keep blood glucose <10mmol/L.


    • Avoid hypo or hyperglycaemia- associated with
    poor functional outcomes.
    • Hypoglycaemia may mimic stroke.
    Monitoring parameters: Body temperature

    • Hyperthermia associated with larger infarcts and


    poor outcome.
    • Could be centrally driven or exogenous.
    • Search for infection and treat.
    • Temperature <37.5 degrees C.
    Monitoring parameters: Fluid and electrolytes

    • Balanced electrolyte and fluid status important to


    avoid:
    – Hypo/hypervolaemia.
    – Plasma volume contraction.
    – Raised haematocrit.
    • Avoid hypotonic fluids.
    Anticoagulation

    • For DVT prophylaxis.


    • No benefit on stroke outcome.
    • However, selected indications for full dose heparin
    e.g. cardiac sources with high risk of re-embolism,
    high grade arterial stenosis.
    THE END

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