Stroke Care

Depends on the type of stroke. First you have to determine wether is was hemorrhagic or due to a thrombosis?

We usually get them Lovenox, TEDS, sequentials, neuro checks minimum of Q4hr x 48 hr, VS q4hr x 48 hr, and pt is usually started on a PO anti-coagulant.

There's nothing they can do to "prevent" or stop a stroke that's already underway from happening. If it's an occusion, or an ischemic stroke, they can try TPA to bust up a clot, but there are several items that the patient needs to qualify for TPA. If the stroke is hemmoragic, they can't do TPA.

They'll usually start patients on anticoagulants if it's ischemic to thin the blood and prevent further clots. The original clot will eventually be reabsorbed.

Reducing stroke risk is all about getting patients to lose weight, stop smoking, stay on their cholesterol meds and control their BP. It's hard to do for many and why we have so many strokes.

With hemmoragic strokes you do NOT want them on blood thinners or the bleeding could increase. With large hemorragic strokes, it's all about controlling ICP and/or surgical interventions to repair the vessels if possible.

There's nothing they can do to "prevent" or stop a stroke that's already underway from happening. If it's an occusion, or an ischemic stroke, they can try TPA to bust up a clot, but there are several items that the patient needs to qualify for TPA. If the stroke is hemmoragic, they can't do TPA.

I work in the ER of a hospital that is a fairly new stroke center- two years. We are good at what we do. but the patient has to give us something to work with. Like the others have said the key is prevention. Next is early recognition of symptoms and calling 911. We can give TPA. it does work but you have to get to use early- with in a 3 hour window, preferably before the last 30 mins We have some blood tests that take time. The CT is the easy part by the way its literally feet down the hall.

Rj

I had an instructor tell the class that TPA is actually too dangerous for most doc's to choose to use. He said that he only saw it used twice and both pt's died. Is this bologna (sp.?) or is there some truth to what he said? (Obviously, for ischemic strokes only, in the right time frame, and fitting the criteria.)

I had an instructor tell the class that TPA is actually too dangerous for most doc's to choose to use. He said that he only saw it used twice and both pt's died. Is this bologna (sp.?) or is there some truth to what he said? (Obviously, for ischemic strokes only, in the right time frame, and fitting the criteria.)

It's balogna (or baloney, depending on your region of the country )

tPA is a very powerful medication. Yes, it should be used with caution and within the appropriate guidelines. Most hospitals have tPA protocols for screening patients. The medication must be given within 3 hours of symptom onset. A stat CT Scan will be done to determine if there is any hemorrhage present prior to administering the tPA. The patient's medical condition and history must also be taken into consideration. Have patients died after receiving tPA? Yes. Have patients' lives been saved and disability reduced with tPA -- also yes! Many ER doctors are hesitant to give tPA because of the risks involved. Having a dedicated stroke team and "strokeologist" (neurologist who specializes in strokes) on staff reduces the risk.

There are other treatments these days too. There is intra-arterial tPA (injected directly into the clotted cerebral artery instead of a systemic intravenous tPA administration). There is also the MERCI clot retriever whereby the clot is removed with a catheter that has a coil on it...similar to a cardiac cath procedure except it is into the cerebral artery. These capabilities are at hospitals with comprehensive stroke centers, usually big university or other tertiary hospitals.

Unfortunately, there is not much new in event of hemorrhagic strokes. They are trying drugs such as Novo7 but the cost of drugs like this are phenomenal and not always successful. Hemorrhagic strokes have a much higher mortality rate than ischemic strokes.

I hope this helps!

Thank you all guys.

It did clear up some confusion I had.

:op