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Approach

The document outlines the emergency management approach for stroke patients, emphasizing resuscitation, history and examination, CT scan protocols, and admission treatments. Key steps include ensuring airway and breathing, monitoring circulation, and administering appropriate medications based on CT findings. Rehabilitation is also highlighted as essential for recovery and promoting brain plasticity.

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ilkelambrechts101
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16 views2 pages

Approach

The document outlines the emergency management approach for stroke patients, emphasizing resuscitation, history and examination, CT scan protocols, and admission treatments. Key steps include ensuring airway and breathing, monitoring circulation, and administering appropriate medications based on CT findings. Rehabilitation is also highlighted as essential for recovery and promoting brain plasticity.

Uploaded by

ilkelambrechts101
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Approach to emergency management of a stroke patient

(Prof Kakaza tutorial)

I. Resuscitation (ABC)
a. Airway and breathing
i.  LOC | GCS < 8  Intubation
ii. Aspiration risk
 NGT
 NPO until speech therapist/OT tests them
b. Circulation
i. If compromised:
 IV line with normal saline
a. HT is the most common cause of stroke therefore
sodium is not good for the patient
 No dextrose or Maintelyte
 Monitor glucose in DM and place on sliding scale

NO GLUCOSE!
 Metabolism  Penumbra ischaemic  Anaerobic respiration  Lactic acid
accumulates  Damage to cell  Oedema

II. History & examination


a. History in keeping with a stroke
b. Examination
i. Neurological
 NB  Power
 Gives vascular distribution/global picture
ii. Cardiovascular
 Pulses (rate, rhythm and volume)
 NB to feel all pulses because of pulselessness that can occur
in a random fashion  Common in females with autoimmune
disease  Takayasu
iii. Blood pressure (usually )
 </= 220/120  Monitor
a. Want to keep it high to ensure brain perfusion
b. Can be part of cushing reflex response to raised ICP
i. Raised BP
ii. Irregular breathing
iii. Bradycardia
 > 220/120
a. IV Labetolol OR
b. Captopril (ACE-I) stat dose
c. NB  Do not use Nifedipine
iv. Respiratory
 Aspiration risk
 Fever/infection detrimental to penumbra
a. If raised  Panado

III. CT scan
a. Ischaemia (more common) vs. haemorrhage
i. No CT scan available  Give everyone aspirin
b. If ischaemic infarct < 4.5 hours  TPA 0.9mg/kg
i. If no TPA available  Aspirin 300mg stat | 150mg daily
c. If haemorrhagic
i. Decrease BP, no medication

IV. Admission
a. Treatment (script)
i. Stroke prevention
 Anti-platelet
a. Aspirin/Disprin
 Anti-hypertensive
 Statin (regardless of cholesterol, to stabilise the plaque)
ii. Clexane +/- 3 days later
iii. Definitive anti-hypertensive treatment
 Day 4
a. ACE-I (promote vascular remodelling)
b. HCTZ (diuretic) to all patients
iv. Rehabilitation (ASAP) to promote plasticity
 Physio
 OT
 Speech therapy

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