Ischemic Stroke Overview

A quick assessment tool used to identify possible stroke in patients.

No symmetrical smile or mouth closing (one side droops).

One arm drifts down when raised equally.

Unable to speak clearly or understandably.

Patients suspected of stroke should be assessed quickly within 10 minutes of arrival at the emergency department.

A type of stroke caused by a blocked artery.

A type of stroke caused by a ruptured blood vessel.

A CT scan is used to determine if the stroke is ischemic or hemorrhagic.

Sudden onset of acute neurologic deficit lasting more than 24 hours, caused by interrupted blood flow to the brain.

Ischemic (blocked artery) and Hemorrhagic (bleeding in brain).

Arterial blockage lasting more than 2-3 hours.

Hypertension, hyperlipidemia, atrial fibrillation, prosthetic heart valves, diabetes, collagen disorders, smoking, oral contraceptives, cardiac disease, neck trauma.

Approximately 795,000 strokes annually; 610,000 are first-time occurrences.

A stroke is a medical emergency requiring immediate attention.

Hemorrhagic strokes (intracerebral and subarachnoid) have higher mortality than ischemic strokes.

A type of stroke caused by interrupted blood flow to the brain.

A chain reaction of events that leads to irreversible brain damage after blood flow is cut off.

The surround tissue around the infarct in a stroke, which can have salvageable tissue with the right intervention and time.

Sudden weakness or numbness on one side of the face.

Sudden weakness or numbness affecting one side of the body (arm, leg, or both).

Difficulty speaking or understanding speech.

Symptoms more typical of hemorrhagic stroke, although possible in ischemic stroke.

Difficulty swallowing or trouble swallowing.

Sudden changes in vision, such as homonymous hemianopsia.

Episodes of abnormal electrical activity in the brain.

Temporary loss of consciousness, often associated with a brief period of decreased blood flow to the brain.

Low blood sugar.

High blood sugar.

The time when stroke symptoms first appeared.

Initial check of Airway, Breathing, and Circulation; crucial before transport.

Specific impairments in body function/movement related to a stroke.

Immediate imaging to rule out bleed and guide stroke management.

Blood sugar level measured to understand its possible impact on stroke.

Assessment of the CNS to identify stroke symptoms.

Standardized test to quantify stroke severity (0-15+).

Bleeding in the area between brain and the surrounding membranes.

A procedure used to get cerebrospinal fluid samples in certain stroke cases.

Treatment protocol timelines for stroke patients based on symptom onset.

Bleeding directly into brain tissue, damaging tissue, causing swelling, and raising pressure.

Hypertension, coagulopathy, anticoagulation, AVMs, aneurysms, and illicit drug use.

Sudden, worsening neurological problems, severe headache, vomiting, high blood pressure (often over 220 mm Hg), and altered consciousness.

Initial assessment of ABCs (Airway, Breathing, Circulation) followed by brain imaging (CT or MRI).

Maintaining ABCs and controlling blood pressure to avoid further damage while adequately perfusing the brain.

Used for high blood pressure (SBP > 200 mmHg or MAP > 150 mmHg) in ICH with frequent monitoring.

Patient requests the Transthoracic Echocardiogram (TTE) test.

Patient experiences persistent symptoms.

Patient has a suspected reason for their symptoms, potentially cardiac.

Patient falls within a particular age group for the study.

Patient has a recent illness, too short to be meaningful for the study.

Patient possesses atypical physical features.

Patient faces limitations in their daily function.

Patient has undergone prior cardiac procedures.

Patient has hearing impairment.

Left ventricular ejection fraction (LVESVI) is outside the acceptable range (-20 to -15).

Patient experiences excruciating chest pain.

Patient has trouble breathing, at a critical level.

Patient is currently experiencing a medical emergency or injury.

Investigating the cause of cardiac-related symptoms.

A brief episode of neurological problems due to a temporary lack of blood flow to the brain, not causing permanent damage.

10-15% of TIA patients will have a stroke within 3 months, half within 48 hours.

A tool used to estimate the risk of stroke happening after a TIA.

Low stroke risk, possible no need for hospital observation.

Moderate stroke risk, warrants hospital observation.

High stroke risk, benefits of hospital observation.

Duration of TIA symptoms; influencing ABCD score.

Symptoms like unilateral weakness/speech impairment influencing stroke risk.

Age 60 or older increases stroke risk after TIA.

High blood pressure (SBP ≥140 mm Hg or DBP ≥90 mm Hg) increases stroke risk after TIA.

Diabetes history increases stroke risk after TIA.

Regularly check vital signs (heart rate, blood pressure, breathing rate, temperature) of the patient receiving a Peripheral Arterial (P.A.) line.

Explain the potential risks and advantages of preventative treatments to the patient.

Regularly assess and manage pain, keep blood pressure within target range (125-160 mmHg), and check blood pressure against pain/discomfort.

Actively watch for potential issues (infection, bleeding) after P.A. insertion and address them promptly if they arise.

Ensure the patient can breathe properly.

Keep a close watch on signs of bleeding from the P.A. insertion site and take action to stop bleeding.

Potential issues that may arise during or after P.A. insertion, such as infections or other unusual events.

The importance of stopping the P.A. insertion process if there are any severe or mild complications.

Conduct a complete head-to-toe evaluation of patient upon a P.A. insertion.

Adjusting band level (ICP) and bed position to manage increased intracranial pressure after P.A. insertion.

Keep an eye on the patient's blood flow.

Vital signs (heart rate, blood pressure, breathing rate, temperature) checks timed at 30 min intervals during the first 4 hrs and 15 min during the first 2 hrs.

Recording patient's condition and any vital changes within the time duration of the insertion.

To move a patient needing more intensive monitoring to a critical care unit.

Monitoring and recording fluid treatment given in response to P.A. line insertion, including vital signs and weights.

Cautious management of low blood pressure, keeping reductions to 20% within a reasonable time frame.

Systolic blood pressure (SBP) ≥ 180 mmHg or mean arterial pressure (MAP) >130 mmHg, with evidence of high intracranial pressure (ICP).

Maintaining blood flow to the brain; target 60-80 mmHg.

Reduce blood pressure to a target of 160/90 mmHg or a MAP of 110 mmHg; re-evaluate every 15 minutes if no elevated ICP.

Potentially harmful to neurological function when done too quickly.

Administer antiepileptic therapy to control seizures.

Elevate the head of the bed to 30 degrees, administer analgesia and sedatives, and potentially more aggressive interventions (osmotic diuretics, hypertonic saline, CSF drainage, neuromuscular blockade).

Maintain blood glucose below 140 mg/dL, avoiding hypoglycemia.

Prevent blood clots by using intermittent pneumatic compression and elastic stockings.

Bleeding into the space surrounding the brain, often caused by aneurysms; associated with high risk of disability and mortality.

Approximately 3% of total strokes and 5% of stroke deaths.

A significant contributor is the rupture of cerebral aneurysms.

Family history, hypertension, smoking, female gender, increasing age and alcohol abuse.

Continuous monitoring in intensive care is necessary for patients with a possible decline in their condition.

May be necessary in some patients with significant SAH.

A severe, unrelenting headache, often described as the "worst headache of my life," that can be a symptom of suspected aneurysm.

A change in the patient's level of awareness and responsiveness.

Unexplained feelings of sickness and urge to vomit.

Intolerance to light.

Stiff neck.

Specific impairments in body functions, such as weakness or numbness on one side of the body.

CT scan without contrast, to rule out bleeding.

Procedure to obtain cerebrospinal fluid if CT scan is negative but SAH suspected.

Priorities are breathing and providing oxygen

Maintain systolic BP between 90-140 mmHg to prevent rebleeding.

Provide pain relief as required

Administer short-acting sedatives if needed

Regular assessments for any deterioration in neurological function

Maintain body temperature below 37.5°C (99.5°F)

Keep the patient from eating or drinking until a swallow test is done

Prevent blood clots using compression devices, not anticoagulants.

Transfer to intensive care unit for close monitoring and necessary interventions.

Referral to a specialized hospital when needed