Academic Day Seminar – Nov 18

✔ Stroke

Anna and Julia did a wonderful job covering ischemic stroke! I haven’t really had much opportunity to encounter stroke in my rotations – so this was a great overview to have! My notes can be found here: stroke

Ways I will apply this:

  • BP management
    • Identify if patient is or is not a candidate for tPA
      – Not on tPA: 15% reduction if >220/120
      – on TPA: target 180/105
      – Choice of BP meds not well-established
      *If on BB PTA, avoid discontinuing or holding to prevent rapid afib or rapid tachycardia – may consider lowering dose of BB if needed*
      – 9/10 of the times, it is hard to control BP in 1st wk after stroke (acute)
    • Keep in mind the pros and cons of lowering BP
    • If patient needs regular BP meds and administration is impeded by swallong difficulities, assess need for NG tube (But avoid NG tube insertion in 1st 24 hours)
  • Assess for VTE prophylaxis
    • evidence for hemorrhagic stroke is low
    • SC LMWH or UFH within 48 hrs of stroke or 24 hrs after thrombolytic admin for ischemic stroke
      – may consider IPC but monitor for skin breaks
  • Differentiating ischemic and hemorrhagic stroke:
    • s/s that are associated with hemorrhagic stroke: coma, neck stiffness, seizures, elevated BP, vomiting and extremely severe headache

Other trials to review: SOCRATES, FASTER

 

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