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Cerebrovascular Accident

CVA, Stroke, Cerebral Apoplexy

Stroke

Sudden loss of neurologic function (speech, movement, or sensation).

How long are the symptoms of a stroke?

24 hours or longer.

The cause is?

a destruction of region of the brain due to an interruption in blood flow to a protion of the brain.

Cerebral thrombosis

one of the cerebral ARTERIES ARE BLOCKED by thrombus, (blood clot).

Cerebral embloism

one of the cerebral arteries is blocked by a clot FLOATING in the blood stream and that becomes wedged in a cerebral artery.

Cerebral bemorrhage

BLEEDING into the brian tissue caused by rupture of a cerebral artery.

Transient Ischemic Attacks

(TIAS) Happens before the real stroke. Little strokes

TIAs

In the monts leading to a CVA a patient may suffer a series of these.

How will the patient feel in between TIAs?

Perfectly Normal

Predoisposing factors

Hypertension
diabetes
****cardic enlargement-steroids
High cholesterol levels
****Oral contraceptives- Birth Control pills.
Cigarette smoking.

Prevention

Medical History. Always take Blood Pressure.
ask History of storke?
ask History of High BP?

BP of 160/100

No dental treatment that day.

ASA IV

No treatment of any kind. patient can't do anything.

ASA III

Patient can't walk up the stairs

ASA II

Patient breaths very heavy while walking up the stairs

ASA I

The patient can run up the stairs

How long after a CVA before treatment?

At leat 6 MONTHS after CVA.

Clinical Manifestations

Face flushed
pounding pulse
if a gradual onset-mild headache
if a sudden onset- SEVERE headache
dizziness
vomiting
sweating
neuologic symptoms
loss of consciousness

When the patient is suffering from the stroke can they understand you?

Yes, never assume they can't. Talk to them about what you are doing and comfort them.

Neuologic Symptoms

droopy face before or after.
paralysis on one side of the body. Left or Right
Inablility to speak or slurring of speech*
pupils are unequal in size
loss of bladder control
difficulty in breathing and swallowing

Treatment

Consult their medical Dr.

Fake Blood clots

Oxycel, Surgicel, Gelfoam

Oxycel

chemically modified forms of surgical gauze used in pressure packs avaliable from surgical suppliers as oxidized cellulose.

Surgicel

Oxidized regenerated cellulose.

Gelfoam

absorbable gelatin sponge

What should the report to their medical Dr. include?

Prothrombin time
only 2x normal
***Patients White Blood Cell count.

Why is the patients white blood cell count included in the report?

because it determines if the patient is at risk for infection or inadequate wound healing.

The patient should be given Lidocaine Plain

No epinephrine

Do NOT give the patient, what meds?

Ibuprofen, Asprin
Advil
diflunisal (Dolobial)
synthetic opioid propoxyphene (Darvon)

What goes in the Medical Alert box?

Warphin.

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