By Ken Uchino
You may have simply encountered a potential stroke sufferer. You wonder, what may still I do first? How do i do know it's a stroke? Is it too overdue to opposite the wear? How do I do the fitting issues within the correct order? This e-book can help you resolution those severe questions. It offers functional suggestion at the care of stroke sufferers in more than a few acute settings. As new and powerful remedies develop into on hand, and exact stroke facilities are created, this guidebook can assist tell the healthcare pros liable for offering care. The content material is prepared in chronological order, protecting the issues to think about in assessing and treating the sufferer within the emergency division, the stroke unit, after which on move to a rehabilitation facility. all kinds of stroke are lined. A finished set of appendices include worthy reference info together with dosing algorithms, conversion elements and stroke scales.
Read Online or Download Acute Stroke Care: A Manual from the University of Texas - Houston Stroke Team PDF
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Extra resources for Acute Stroke Care: A Manual from the University of Texas - Houston Stroke Team
What is the stroke location and mechanism? What strategies are we using to prevent another stroke? 31 n n n n n n n n n n n n n n n n n n n n n n n n Ischemic stroke 32 n n n n n n n n n n n n n n n n n n n n n n n n . Is the patient on any antihypertensives, in particular ACE inhibitor? , aspirin, aspirin/ dipyridamole, or clopidogrel)? Is the patient’s LDL < 100 mg/dl and is he or she on a statin? Get rid of unnecessary drugs. Is the follow-up plan established? If the patient is discharged on warfarin, who will be following the INR?
MORTALITY Overall (data from Rochester Epidemiology Project and NOMASS):10,11 . $30% mortality in the first year. 40–50% in 5 years. From Medicare database (age ! 65 years):12 . 4% . After surviving a TIA hospitalization, 15% mortality in 1 year, mortality in 1 year, 60% mortality after 5 years. 50% mortality in 5 years. DISABILITY More importantly than mortality, patients and families usually are anxious to know their likely functional outcome. This is very difficult to predict in the first few days in an individual patient.
Known history of intracranial hemorrhage. Symptoms suggestive of subarachnoid hemorrhage. Any evidence of bleeding on the pretreatment head CT – It is uncertain whether patients with ‘‘microbleeds’’ that are seen on gradient echo MRI (and not CT) can be safely treated. Most recent data suggest that they do not pose an increased risk of bleeding after TPA, but the data are still inconclusive. However, if there is any bleeding seen on the CT, the patient should not be treated. Intracranial neoplasm, untreated arteriovenous malformation (AVM), or aneurysm that is at risk of bleeding – If the patient Strong contraindications has an aneurysm or AVM that has been surgically clipped or repaired more than 3 months ago, we would probably allow treatment, though we would probably do a CT angiogram first to confirm obliteration of the lesion.