Stroke (main)
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