Stroke (main)

Revision as of 23:38, 1 March 2011 by Robot (talk | contribs)

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