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12 Cards in this Set
- Front
- Back
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Medical management of acute stroke |
1. Maintain serum glucose <140 mg/dL )7.8 mmol/L) 2. Administer normal saline IV, 1.5mL/kg hourly initially, with a goal of euvolemia; avoid dextrose-containing fluids 3. Continue cardiac monitoring 4. Treat fever 5. NPO 6. Acute BP goal <220/110 mm Hg (without IV tPA) or <185/110 mm Hg with tPA |
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Besides elapsed time, what is the most common exclusion criteria for tPA? |
Rapid, spontaneous improvement and mild deficit |
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A rule of thumb regarding tPA administration? |
Proceed with IV tPA, despite early reports of clinical improvement, if a patient's stroke symptoms and signs are still present at the conclusion of the stroke team's preliminary assessment (which includes history, physixcal examination, evaluation with the NIHSS, lab tests, and neuroimaging) |
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What are the additional exclusion criteria during hour 3 to 4.5 for tPA? |
1. Age >80 2. Anticoagulant use (regardless of INR) 3. NIHSS score >25 4. History of prior stroke and diabetes mellitus |
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Complications of tPA that should be looked for? |
1. Hemilingual edema 2. Angioedema 3. Intracranial hemorrhage 4. Systemic hemorrhage 5. Hemorrhagic transformation is a consideration if a patient has a sudden severe headache; worsening neurologic deficit; or reduced level of consciousness |
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In case of suspected hemorrhagic transformation, what should be done? |
1. Stop tPA 2. Draw blood for INR, aPTT, platelets, fibrinogen level, and blood typing and cross matching 3. CT of the head |
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If hemorrhagic transformation is confirmed on CT, what is the next step? (4) |
1. Consult neurosurgery 2. Administer 6 to 8 units of IV cryoprecipitate 3. Administer 6 to 8 units of platelets 4. Consider administering 40 to 80 mg/kg of recombinant activated factor VIIa while waiting for the response to platelets and cryoprecipitate |
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Who would be candidates for endovascular therapy? |
Patients in whom symptoms began less than 8 hours ago and who have large arterial occlusion, e.g., in the MCA; intracranial ICA, or basilar artery |
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Large intracranial arterial occlusions are generally suspected when? |
Moderate or severe stroke syndrome NIHSS >10 or 20, and confirmed radiologically by CT angiography, MRA, or conventional catheter angiography |
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Which stroke candidates are good candidates for ICU? |
1. Status at risk for deterioration due to malignant middle cerebral artery ischemic stroke 2. Reduced level of consciousness 3. Comorbidities requiring frequent monitoring |
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Admission orders should address, at a minimum? |
1. Blood glucose level 2. Temperature 3. Volume status 4. Swallowing assessment 5. Placement of catheters 6. DVT prevention |
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If tPA was administered, medical management? (4) |
1. Admit to ICU? 2. Avoid invasive procedures (avoid use of indwelling urinary catheter, nasogastric tubes, and intra-articular catheters for >4hrs) 3. Do not administer antiplatelet or anticoagulant medications for >24 hrs 4. Frequently check vital signs and neurologic status |
