Acute care for Ischemic stroke

Acute care for Ischemic stroke
- Begins with managing
  - Airway
  - Breathing
  - Circulation
- Baseline neurologic assessment
  - Monitor closely for
    - Signs of increasing neurologic deficit
    - Increased ICP
  - Elevated BP is common immediately after a stroke
    - May reflect body’s attempt to maintain cerebral perfusion
- Recombinant tissue plasminogen activator (tPA)
  - Used to reestablish blood flow through a blocked artery to prevent cell death
  - Must be administered within 3 to 4 ½ hours of onset of clinical signs of ischemic stroke
  - Patients are carefully screened
- After the patient has stabilized and to prevent further clot formation, patients with strokes caused by thrombi and emboli may be treated with anticoagulants and platelet inhibitors
- ASA, ticlopidine, clopidogel, dipyridamole
Endovascular therapy
- Stent retrievers
  - Becoming the most effective way of managing ischemic stroke
Acute care for hemorrhagic stroke
- Goals are the same as for the patient with ischemic stroke
  - Manage
    - Airway
    - Breathing
    - Circulation
    - Intracranial pressure
- Hyperdynamic therapy
  - Increase mean arterial pressure
  - Increase cerebral perfusion
  - Crystalloid or colloid solutions
- Vasospasms can be treated with calcium channel blocker nimodipine (Nimotop)