Stroke (main)

Revision as of 19:40, 16 July 2011 by Rossdonaldson1 (talk | contribs) (Ischemic)

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)
  3. If pt is tPA candidate go to --> CVA (tPA Criteria)
    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
  4. 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