Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Acute Stroke Assessment (ROSIER&NIHSS) |Atrial Fibrillation |Atrial Myxoma |Causes of Stroke |Ischaemic Stroke |Cancer and Stroke |Cardioembolic stroke |CT Basics for Stroke |Endocarditis and Stroke |Haemorrhagic Stroke |Stroke Thrombolysis |Hyperacute Stroke Care
โฑ๏ธ Time is Brain: Every minute of untreated large vessel stroke costs ~1.9 million neurons. Target: CT within 1 hour and thrombolysis within 30 minutes of arrival.
Actions | Comments |
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๐ซ ABC | Airway, breathing, circulation first. Oxygen only if hypoxic. Consider ITU if GCS < 9. Record NIHSS score. |
๐ฉธ Blood Glucose | Treat hypoglycaemia immediately (fingerstick test acceptable). |
๐ Assess for Thrombolysis | rt-PA within 3 h (>80y) or 4.5 h (<80y). Door-to-needle target: <30 min. |
๐ฉป Assess for Thrombectomy | Mechanical thrombectomy if CTA shows LVO. Best <6 h, can extend to 16โ24 h in select cases. |
๐ง Haemorrhage / Raised ICP | Consult neurosurgery. Consider EVD, sub-occipital craniectomy (cerebellar bleed), or hemicraniectomy (malignant MCA). |
๐งช Haemorrhage with Coagulopathy | Reverse anticoagulation: PCC + Vit K (Warfarin), Praxbind (Dabigatran), platelets if thrombocytopenia. |
Actions | Comments |
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๐ถ/๐ต Age | <80y โ 4.5h window; โฅ80y โ 3h window. |
๐ Time Since Last Well | Use last well time if onset unclear. |
๐ Anticoagulation | Contraindicates thrombolysis โ but not thrombectomy โ๏ธ. |
๐ NIHSS Score | Reperfusion rarely offered if NIHSS <4 (minor) or >25 (very severe). |
๐ Premorbid State | Benefit less likely if already mRS 4โ5 (high dependency). |
๐ฉป CT Report | Avoid referral if CT shows haemorrhage, tumour, or extensive infarction. |
โ๏ธ Comorbidities | Advanced malignancy / recent trauma may contraindicate treatment. |
๐ฉบ Blood Pressure | Must be <185/110 mmHg before Alteplase. |
Managing & Preventing Early Complications | |
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๐ฅค Swallow Assessment | Screen within 4 h to prevent aspiration pneumonia. |
๐ฝ๏ธ Feeding | NG tube if swallow unsafe. |
๐ฆต VTE Prevention | IPC stockings first-line. Avoid LMWH until ICH excluded. |
๐ง Hydration | IV fluids to prevent dehydration. |
๐๏ธ Skin Care | Regular turns to prevent pressure sores. |
๐ฝ Bowel Care | Prevent constipation. |
๐ช Shoulder Protection | Support joint to avoid subluxation. |
๐ Therapy | Early mobilisation & rehabilitation. |
โก Seizure Management | Treat promptly; seizures may indicate large infarct. |
๐ฆ Infection | Treat UTIs & chest infections early. |
๐ง Bladder Care | Promote continence; avoid catheters if possible. |
๐ Exam pearls: - BP must be <185/110 before thrombolysis. - Hypo- or hyperglycaemia worsens outcome. - Seizures at onset โ consider stroke mimic. - Swallow screen within 4 h is a national quality standard.
FAST positive โ CT within 1 h โ Thrombolysis if eligible (<4.5 h) โ CTA for thrombectomy if LVO โ Admit to HASU for monitoring & prevention.