[mommy2boys]

I was how your ER/hospital would treat a stroke patient. What are some of the different treatments for a mini stroke vs a massive stroke?

I'm not looking for medical advice, just on how different hospitals treat a patient that presents with a stroke.

TIA
ERin

[RunnerRN]

Obviously it differs on the patient. If onset is definitely less than 3 hrs PTA, and no bleed on the scan (or other contraindicating factors) then we will give tPA. Many of our strokes are already resolving by the time they get into us, so no tPA and just supportive care.
This reminds me of a very interesting case from a few weeks ago. 70ish man, cardiac hx. He woke up with chest pressure, wife gave him Ntg SL x 3. The pressure went away, but then he started acting confused and had L sided weakness. So what happened? The Ntg dropped his pressure which caused the infarct. The doc referred to it as a "watershed" stroke. I had never seen that before, and found it fascinating - but so sad. There was nothing we could do....couldn't give Beta blockers to treat the MI bc that would drop his pressure and extend his CVA, couldn't give tPA because he'd had surgery pretty recently. I just hope no one ever explained all this to the wife. I thought it was a really interesting teaching case.

[jmgrn65]

If the stroke occured within a certain time frame, and it isn't contraindicated they get TNK or ooooh I cant think but it is the same stuff for MI's but dosage is different. Otherwise it is just to treat symptoms and r/o bleeds. Do ct scan or mri to r/o why.

[TazziRN]

If there is no bleed and no clot, and symptoms have self-resolved, we would admit the pt for observation. If the above signs are seen we would transfer out.

[snowfreeze]

When a patients arrives or presents with stroke symptoms the Stroke team is activated. Stat blood work, CT scan and then treatment depending on the outcome of coag levels and CT scan. Brain MRIs are not uncommon. Carotid doppler studies are utilized also. Stroke team from our main facility will guide treatment depending on outcome of tests. Searching for reason for this CVA is our goal so as to treat and prevent further injury. Some are given clot busters, some are sent for immediate surgery, some are sent to ICU intubated and close observation. Some are showing signs of recovery and are sent to a stroke trained unit. Each recovery phase has specific guidelines to follow.

[Altra]

Originally Posted by jmgrn65

If the stroke occured within a certain time frame, and it isn't contraindicated they get TNK or ooooh I cant think but it is the same stuff for MI's but dosage is different. Otherwise it is just to treat symptoms and r/o bleeds. Do ct scan or mri to r/o why.

Integrilin ?

[Altra]

Originally Posted by snowfreeze

When a patients arrives or presents with stroke symptoms the Stroke team is activated. Stat blood work, CT scan and then treatment depending on the outcome of coag levels and CT scan. Brain MRIs are not uncommon. Carotid doppler studies are utilized also. Stroke team from our main facility will guide treatment depending on outcome of tests. Searching for reason for this CVA is our goal so as to treat and prevent further injury. Some are given clot busters, some are sent for immediate surgery, some are sent to ICU intubated and close observation. Some are showing signs of recovery and are sent to a stroke trained unit. Each recovery phase has specific guidelines to follow.

Similar course where I work, but we (the ER) are the stroke team.

[nuangel1]

if sx in 3 hrs tpa ct first to r/o bleed .if over 3 hrs monitor tx and observe .sometimes we transfer also.