Acute management (first hours) for stroke

Acute management (first hours) for stroke   ABCS 1.       Ensure airway a.       (to avoid hypoxia/aspirat)2.       Monitor blood glucose a.       Keep BM 4-11mmol/L 3.       Monitor BPa.       But treating even very high may harm b/c autoreg impaired, even a 20% fall may compromise cerebral perfusionb.      If on HRT, stop it4.       Urgent CT/MRI if :                           *CT will rule out py haemorrhage          *MRI most sensitive for an acute infarct a.       thrombolysis consideredb.      cerebellar stroke                                                               i.      cerebellar hemartomas may need urgent evac c.       unusual presentation                                                               i.      ie alt diagnosis likely d.      high risk of haemorrhage                                                               i.      decreased GCS, raised ICP signs, severe headache, meningism, progressive symps, known bleeding tendency or anticoagulation e.       (otherwise imaging can wait – aim 5.       Thrombolysis a.      Consider if 18-80y b.      Symp onset c.       + NO contraindic                                                                i.      Major infarct or haemorrhage on CT                                                              ii.      Mild (non-disabling) deficits                                                             iii.      Recent surg, trauma, or obstetric delivery                                                            iv.      Past CNS haemorrhage                                                              v.      AVMalform or aneurysm                                                            vi.      Severe liver disease, varices, or portal hypertens                                                           vii.      Seizures at presentation                                                         viii.      Recent arterial or venous punct at non compressible site                                                            ix.      Anticoags or PTT >15s                                                              x.      Platelet                                                            xi.      BP >220/130 6.       ‘Nil by mouth’ until swallowing assessed 7.       Keep hydrated a.      But not over hyd (risk of cereb edema) 8.       Explain what has happened a.      Communic fully w/pt, rels + carers over difficult decisions eg deciding on kindest lvl of intervention taking into account qual of life, coexist condits, prognosis 9.       Antiplatelet agents- once hemorrhagic stroke exclude, give aspirin 300mg 10.   Admission to stroke unit for specialist nursing/physio saves lives + is great motivator

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