Emergency: Stroke

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Author:
ghrelin23187
ID:
226729
Filename:
Emergency: Stroke
Updated:
2013-07-11 16:36:27
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Description:
Stroke
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  1. Difference between stroke and MI. Explain why aspirin is not suited for stroke
    • Coronary artery can't rupture.
    • Stroke could be a result of hemorrhage --> aspirin could elevate the stroke
  2. how does stroke affect brain?
    brains require lots of oxygen and can't last very long without it.
  3. stroke: classification
    Occlusion and Hemmorrhagics
  4. Occlusive strokes: subtypes
    thrombotic (in the brain): more common

    Embolic(away from the brain): less common
  5. Fatality: occlusive vs hemorrhagic strokes
    Hem. stroke is more fatal
  6. Which type of strokes is more likely to happen in dental office? why?
    Hemorrhagic strokes and bc of stress
  7. TIA vs strokes: difference
    reversible and complete resolution within 24
  8. Stroke - Relative Risk
    • --Similar risk factors as for C.A.D : smoking,
    • hypertension, diabetes, elevated cholesterol, family history

    • --Hypertension carries the greatest
    • relative risk

    --Cardiac arrhythmias

    --Valvular heart disease

    --Carotid artery disease

    --History of previous CVA (20% within 1-2 years)
  9. Stroke - Precipitating Factors: in dental office
    In the dental setting, a sudden rapid increase in blood pressure is the greatest precipitating event.
  10. Stroke - Prevention
    When to treat?  6 month rule

    Confirm that patient took antihypertensive   medications

    Check the blood pressure

    Stress reduction (sedation can mask neurologic symptoms)

    Judicious use of epinephrine
  11. Stroke - Recognition: general symptom
    Variable (depending on location of cerebral infarct)

    Localized weakness

    Numbness

    Aphasia 

    Severe headache

    Vomiting  

    Seizure

    Loss of consciousness
  12. Stroke symptoms - recognition: clinical symptom
    • Sudden numbness or weakness of
    • face, arm or leg - especially on one side of the body.

    • Sudden confusion, trouble speaking
    • or understanding.

    • Sudden trouble seeing in one or
    • both eyes.

    • Sudden trouble walking, dizziness,
    • loss of balance or coordination.

    • Sudden severe headache with no
    • known cause.
  13. Stroke - Treatment
    Stop dental procedure

    Position patient sitting upright (if conscious) to decrease intracranial pressure.

    911—Seconds count.  Stroke victims who receive tPA within three hours are 30% more likely to recover with little or no neurologic deficit. 

    Oxygen

    Monitor vital signs

    Basic Life Support if needed
  14. Stroke at the emergency room
    brain scan --> hemorrhage --> craniotomy to evacuate blood

    no blood on brain scan --> receive tPA which dissolve blood clot --> prevent neurologic deficit
  15. stroke pt showed up at hospital with brain scan showing hemorrhage. what's next?
    Craniotomy to evacuate blood
  16. Stroke pt showed up at hospital with brain scan showing no hemorrhage. What's next?
    administer tPA to dissolve clock

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