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20 terms

Acute Stroke Case

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Drugs for stroke pt
approved fibrinolytic agent, glucose-D50, Labetalol, Nitroprusside, Nicardipine and aspirin
name the two types of stroke
1. ischemic stroke- 85% of strokes- cuased by block atery in the brain. 2. hemorrhagic stroke-15% of stroke-a blood vessel in the brain suddenly bursts- obviously fibrinolytics or anticoagulants would not be given in this type of stroke!
How early must fibrinolytic therapy be provided in ischemic stroke victims? this is the door-to admission time goal
should be given w/in 3 hours of onset of sx.
How can we confirm a pt has had a stroke?
getting a CT scan- should be interpreted 45 min after pt arrival to the ED
what are the first two drugs to be given to stroke pt?
oxygen and glucose
What do you do if a stoke pt is admitted?
w/in 10 min= ABCs and vital signs, give oxygen if hypoxemic, get IV access and take blood samples, check glucose-treated if indicated, perform neurologic screening assessment, activate stoke team, oder CT scan of brain, get 12-lead EKG
What is very important to get in stoke persons history?
Time of sx onset
What if the CT scan shows hemorrhage?
the do prepare for fibrinoloytics. This person had a rupture or brain bleed
sings and symptoms of stoke?
sudden weakness or numbness of the face, arm, or leg- especially on one side of the body. Sudden confusion. Trouble speaking or understanding, sudden trouble seeing or walking . Dizziness or loss of balance, sudden severe HA with no known cause
What three things do you ask the pt is do in the cincinnati prehospital stroke scale?
-ask the pt to smile (look for droop on one side. -have the pt close eyes and hold both arms out (look for one that drifts)- Have the pt say- tou can't treach an old dog new trcks. Listen for slurs, wrong words or unable to speak
How do you know if you need to give the pt oxygen?
if they are hypoxemic-which is <92% O2 sat. but in stroke still consider giving oxygen regardless.
what do you obtain blood samples for?
establish IV access and then obtain blood samples for baseline blood count, coagulation studies, and blood glucose
why do you check the blood glucose in stoke victims?
so you can promptly treat hypoglycemia
why do stroke victim need a 12 lead ECG?
AMI or arrhythmias can cause embolic stroke. Life-threatening arrhythmias can follow or accompany a stoke.
would you dealy a CT scan to obtain a 12 lead ECG?
No- do not dealy getting a CT scan in stroke victims
What kind of fibrinolytic agent is given for acute ischemic stoke?
Alteplase Recombinant (tPA)
What should you not given during the first 24 hours of fibrinolytic therapy?
no aspirin or heaprin
what is tPA?
tissues plaminogen activator- The classic role of tPA is in the clotting system. To be specific, tPA catalyzes the conversion of plasminogen into plasmin.
what is tPA used for?
tPA is used in diseases that feature blood clots, such as pulmonary embolism, myocardial infarction, and stroke, in a medical treatment called thrombolysis.
name some Recombinant tissue plasminogen activators- tPAs
Recombinant tissue plasminogen activators (r-tPAs) include alteplase, reteplase, and tenecteplase (TNKase).[3]

Alteplase is FDA-approved for treatment of myocardial infarction with ST-elevation (STEMI), acute ischemic stroke (AIS), acute massive pulmonary embolism, and central venous access devices (CVAD).[3]

Reteplase is FDA-approved for acute myocardial infarction, where it has more convenient administration and faster thrombolysis than alteplase.[3]

Tenecteplase is also indicated in acute myocardial infarction, showing fewer bleeding complications but otherwise similar mortality rates after one year compared to alteplase