‘BRAIN ATTACK’
IF YOU HAVE ANY ONE OF THESE SIGNS…YOU GOT YOURSELF A CVA!!
F: facial droop
-have pt. smile/show teeth
-one side of face will not move as well
A: arm drift
-pt. closes eyes and extends both arms straight out with palms up
-abnormal: one arm will not move or one arm drifts downward
A: abnormal speech
-abnormal: pt slurs words…uses the wrong word….unable to speak
ER TX:
-ABC
-know the time of onset of Sx….MOST IMPORTANT POINT IN PT HX!!!!
-O2; IV; GLUCOSE CHECK….HYPOGLYCEMIA CAN MIMIC STROKE!!!!
-NON CONTRAST CT OF HEAD!!!...DIFFERENTIATES BTW CLOT AND BLEED!!!!!
-get done 25 min from arrival in ER
-CT COMPLETED IN 20 MIN!!
-tPA if clot w/in 3-4.5 hrs of onset of S/S!!!
TYPES:
Ischemic 85%
Hemorrhagic 15%
TIA…transient ischemic attack
Thrombotic
Embolic
, TIA….80%
-partial or complete occlusion of artery
-warning sign of progressive cerebrovascular disease
-Symptoms last <1hr
Carotid: temporary loss of vision in one eye….transient hemiparesis…numbness/loss of
sensation…sudden inability to speak
Vertebrobasilar System: Tinnitus/vertigo…darkened/blurred
vision/diplopia/ptosis…dysarthia/dysphagia…ataxia..weakness…
unilateral or
bilateral
DX…prewarning:
-CT….US CAROTIDS…ECHO HEART
TX:…invasive….correct before stroke
MEDS: antiplatelet
-ASA…most frequently used
-Plavix
-STATINS…dec cholesterol
-Coumadin with AFIB
DC 1-14 days before cutting
Prevention/change in lifestyle….healthy diet…wt control..regular exercise…NOOO
SMOKING!! NO SMOKING!! NO SMOKING!! SERIOUSLY…YOUR BREATH SMELLS LIKE ASS WHEN YOU
DO AND YOUR TEETH LOOK DISGUSTING. WE DON’T LIVE IN THE 1920’S WHEN SMOKING WAS
ATTRACTIVE. CUT THAT SHIT OUT!!!...limit adult drinky dranks….routine health assessment with risk
factors like HTN, etc.
Acute Ischemic Stroke
Thrombotic…most common!!!...narrowing/occlusion….HTN; DM PT MOSTLY HAVE THIS!!!!
Embolic...embolus occludes in cerebral artery….embolus usually comes from heart ….S/S: can
progress in 1st 72hrs when ICP peaks…amt of damage depends on size of infarct
and
location.
IF YOU HAVE ANY ONE OF THESE SIGNS…YOU GOT YOURSELF A CVA!!
F: facial droop
-have pt. smile/show teeth
-one side of face will not move as well
A: arm drift
-pt. closes eyes and extends both arms straight out with palms up
-abnormal: one arm will not move or one arm drifts downward
A: abnormal speech
-abnormal: pt slurs words…uses the wrong word….unable to speak
ER TX:
-ABC
-know the time of onset of Sx….MOST IMPORTANT POINT IN PT HX!!!!
-O2; IV; GLUCOSE CHECK….HYPOGLYCEMIA CAN MIMIC STROKE!!!!
-NON CONTRAST CT OF HEAD!!!...DIFFERENTIATES BTW CLOT AND BLEED!!!!!
-get done 25 min from arrival in ER
-CT COMPLETED IN 20 MIN!!
-tPA if clot w/in 3-4.5 hrs of onset of S/S!!!
TYPES:
Ischemic 85%
Hemorrhagic 15%
TIA…transient ischemic attack
Thrombotic
Embolic
, TIA….80%
-partial or complete occlusion of artery
-warning sign of progressive cerebrovascular disease
-Symptoms last <1hr
Carotid: temporary loss of vision in one eye….transient hemiparesis…numbness/loss of
sensation…sudden inability to speak
Vertebrobasilar System: Tinnitus/vertigo…darkened/blurred
vision/diplopia/ptosis…dysarthia/dysphagia…ataxia..weakness…
unilateral or
bilateral
DX…prewarning:
-CT….US CAROTIDS…ECHO HEART
TX:…invasive….correct before stroke
MEDS: antiplatelet
-ASA…most frequently used
-Plavix
-STATINS…dec cholesterol
-Coumadin with AFIB
DC 1-14 days before cutting
Prevention/change in lifestyle….healthy diet…wt control..regular exercise…NOOO
SMOKING!! NO SMOKING!! NO SMOKING!! SERIOUSLY…YOUR BREATH SMELLS LIKE ASS WHEN YOU
DO AND YOUR TEETH LOOK DISGUSTING. WE DON’T LIVE IN THE 1920’S WHEN SMOKING WAS
ATTRACTIVE. CUT THAT SHIT OUT!!!...limit adult drinky dranks….routine health assessment with risk
factors like HTN, etc.
Acute Ischemic Stroke
Thrombotic…most common!!!...narrowing/occlusion….HTN; DM PT MOSTLY HAVE THIS!!!!
Embolic...embolus occludes in cerebral artery….embolus usually comes from heart ….S/S: can
progress in 1st 72hrs when ICP peaks…amt of damage depends on size of infarct
and
location.
