Difference between revisions of "Stroke (main)"

Line 1: Line 1:
 
==Work-Up==
 
==Work-Up==
 
+
# Glucose check
 
+
# CBC, chemistry, coags, troponin
* Glucose check
+
# Lipid profile
* CBC, chemistry, coags, troponin
+
# Head CT
* Lipid profile
+
# ECG (a. fib)  
* Head CT
+
# Also consider:
* ECG (a. fib)  
+
## Pregnancy test
* Also consider:
+
## Utox
* Pregnancy test
+
## TTE with bubble study
* Utox
 
* TTE with bubble study
 
 
  
 
==DDX Ischemic==
 
==DDX Ischemic==
 
+
# Thrombosis (atherosclerosis, vasculitis, dissection)
 
+
# Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable)
* Thrombosis (atherosclerosis, vasculitis, dissection)
+
# Vasospasm
* Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable)
+
# Hypotension/watershed  
* Vasospasm
 
* Hypotension/watershed  
 
 
  
 
==Treatment==
 
==Treatment==
 
+
===Ischemic===
 
+
# Glycemic control
* Ischemic
+
## Use insulin to maintain blood sugar < 185
* Glycemic control
+
# Temperature control
* Use insulin to maintain blood sugar < 185
+
## Treat fever > 37.5 (99.5)  
* Temperature control
 
* Treat fever > 37.5 (99.5)  
 
 
   
 
   
 +
#If pt is tPA candidate (CVA (tPA criteria and dosing)
 +
## Consider tPA
 +
### If give tPA DO NOT give antiplatelets/anticoagulants for at least 24 hours
 +
## BP Control
 +
### If potential candidate for tPA but BP > 185/110:
 +
#### Labetalol 10-20mg IV over 1-2min, may repeat x 1, OR
 +
#### Nicardipine IV 5mg/hr, titrate up by 2.5mg/hr q5-15min, max 15mg/hr; when desired BP reached lower to 3mg/hr OR
 +
#### other agents (hydralazine, enalaprit, etc) may be considered when appropriate
 +
# If pt is NOT a tPA candidate:
 +
## Aspirin
 +
## BP control
 +
### Only tx BP if > 220/120
 +
## Anticoagulation
 +
### Heparin only if cardiac embolic source/ a-fib 
  
* If pt is tPA candidate (CVA (tPA criteria and dosing)
+
===Hemorrhagic===
* Consider tPA
+
See Intracranial Hemorrhage (ICH)  
* If give tPA DO NOT give antiplatelets/anticoagulants for at least 24 hours
 
* BP Control
 
* If potential candidate for tPA but BP > 185/110:
 
* Labetalol 10-20mg IV over 1-2min, may repeat x 1, OR
 
* Nicardipine IV 5mg/hr, titrate up by 2.5mg/hr q5-15min, max 15mg/hr; when desired BP reached lower to 3mg/hr OR
 
* other agents (hydralazine, enalaprit, etc) may be considered when appropriate
 
* If pt is NOT a tPA candidate:
 
* Aspirin
 
* BP control
 
* Only tx BP if > 220/120
 
* Anticoagulation
 
* Heparin only if cardiac embolic source/ a-fib 
 
* Hemorrhagic
 
* See Intracranial Hemorrhage (ICH)  
 
 
  
 
==Source==
 
==Source==
 
 
 
8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07)  
 
8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07)  
  
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AHA/ASA Acute Stroke Guidelines
 
AHA/ASA Acute Stroke Guidelines
 
 
 
  
 
[[Category:Neuro]]
 
[[Category:Neuro]]

Revision as of 06:25, 28 March 2011

Work-Up

  1. Glucose check
  2. CBC, chemistry, coags, troponin
  3. Lipid profile
  4. Head CT
  5. ECG (a. fib)
  6. Also consider:
    1. Pregnancy test
    2. Utox
    3. TTE with bubble study

DDX Ischemic

  1. Thrombosis (atherosclerosis, vasculitis, dissection)
  2. Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable)
  3. Vasospasm
  4. Hypotension/watershed

Treatment

Ischemic

  1. Glycemic control
    1. Use insulin to maintain blood sugar < 185
  2. Temperature control
    1. Treat fever > 37.5 (99.5)
  1. If pt is tPA candidate (CVA (tPA criteria and dosing)
    1. Consider tPA
      1. If give tPA DO NOT give antiplatelets/anticoagulants for at least 24 hours
    2. BP Control
      1. If potential candidate for tPA but BP > 185/110:
        1. Labetalol 10-20mg IV over 1-2min, may repeat x 1, OR
        2. Nicardipine IV 5mg/hr, titrate up by 2.5mg/hr q5-15min, max 15mg/hr; when desired BP reached lower to 3mg/hr OR
        3. other agents (hydralazine, enalaprit, etc) may be considered when appropriate
  2. If pt is NOT a tPA candidate:
    1. Aspirin
    2. BP control
      1. Only tx BP if > 220/120
    3. Anticoagulation
      1. Heparin only if cardiac embolic source/ a-fib

Hemorrhagic

See Intracranial Hemorrhage (ICH)

Source

8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07)

UpToDate

AHA/ASA Acute Stroke Guidelines