Stroke (main): Difference between revisions
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==Work-Up== | ==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== | ==DDX Ischemic== | ||
# Thrombosis (atherosclerosis, vasculitis, dissection) | |||
# Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable) | |||
# Vasospasm | |||
# Hypotension/watershed | |||
==Treatment== | ==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== | ==Source== | ||
8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07) | 8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07) | ||
Line 58: | Line 47: | ||
AHA/ASA Acute Stroke Guidelines | AHA/ASA Acute Stroke Guidelines | ||
[[Category:Neuro]] | [[Category:Neuro]] |
Revision as of 06:25, 28 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 potential candidate for tPA but BP > 185/110:
- Consider tPA
- 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