Stroke (main): Difference between revisions
(Created page with "==ER Work-Up== 0) Icon/Glu check 1) Head CT (non-con) 2) ECG (a. fib) 3) UA/Utox 4) CBC, Chem 7, LFTs, PT/PTT 4+) Trop (in elderly; poss silent MI) ==DDX Ischemi...") |
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== | ==Work-Up== | ||
* Glucose check | |||
* CBC, chemistry, coags, troponin | |||
* Lipid profile | |||
* Head CT | |||
* ECG (a. fib) | |||
* Also consider: | |||
* Pregnancy test | |||
* Utox | |||
* TTE with bubble study | |||
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* Thrombosis (atherosclerosis, vasculitis, dissection) | |||
* Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable) | |||
* Vasospasm | |||
* Hypotension/watershed | |||
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* Ischemic | |||
* Glycemic control | |||
* Use insulin to maintain blood sugar < 185 | |||
* 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 | |||
* Hemorrhagic | |||
* See Intracranial Hemorrhage (ICH) | |||
==Source== | |||
8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07) | |||
UpToDate | |||
AHA/ASA Acute Stroke Guidelines | |||
Revision as of 23:38, 1 March 2011
Work-Up
- Glucose check
- CBC, chemistry, coags, troponin
- Lipid profile
- Head CT
- ECG (a. fib)
- Also consider:
- Pregnancy test
- Utox
- TTE with bubble study
DDX Ischemic
- Thrombosis (atherosclerosis, vasculitis, dissection)
- Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable)
- Vasospasm
- Hypotension/watershed
Treatment
- Ischemic
- Glycemic control
- Use insulin to maintain blood sugar < 185
- 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
- Hemorrhagic
- See Intracranial Hemorrhage (ICH)
Source
8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07)
UpToDate
AHA/ASA Acute Stroke Guidelines