In The Name Of God.

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Presentation transcript:

In The Name Of God

Presented by: Dr Kadivar neurologist at Hazrat e Aliasghar Hospital Ischemic CVA Presented by: Dr Kadivar neurologist at Hazrat e Aliasghar Hospital

What Do you should know? Definition of ISCHEMIC CVA Localization Approaches at ER Maintenance therapy Hospital care

Sudden onset vascular insult, due to embolic process and or thrombotic etiology and or total occlusion. At cortical infarction: contralateral weakness, gaze to cortical infarction site, contralateral homonymous hemianopia,…….. At brainstem infarction: contralateral weakness and gaze to this site……

Case 1 A case of 70 y/o female with suddenly confusional state and lt sided weakness, dysarthria, lt central facial palsy, Dysphasia….. BP:200/110 T:37.5 ECG: Nl rhythm 73/min BS: 280 mg/dl LDL:110 GCS:9 Hb:10.5 PMHx: DM2 , HTN , Smoker

A B C D approaches Position:30◦ Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex) Save BP <220/120 for 48 – 72 hours NPO for 24 hours and reevaluation again. Heart monitoring & pulse oximetry Iv fluid therapy normal saline Save BS <200mg/dl , check with glucometer q6hour Blood transfusion if Hb <10 TG,cholestrol,LDL,HDL (WHAT’S LDL Goals?) Physiotherapy at chest, extremities….. Hold Asprin,Plavix,Heparin, Atorvastatin for at least 72 hours Please intubate the patient if GCS dropped or signs of herniation detected.

Case 2 A case of 68y/o male with suddenly slurred speech, Rt sided weakness, drowsiness, headache from this morning…. BP:195/105 BS: 350 CR:2.7 Bun: 30 HB:9 ECG: fibrillation rhythm PMHx: AF, HTN, CRF, DM2

A B C D approaches Position: flat for 24 hours and then at 30◦ Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex) NPO for 12- 24 hours and reevaluation again. Heart monitoring & pulse oximetry Iv fluid therapy normal saline Save BP <180/100 due to renal failure, with Labetalol 2-4 cc in 5cc NS at 3min and re-evaluate BP 10 minute late (total dose is 300 mg) Transfuse 1 bag P-RBC TG,cholestrol,LDL,HDL Physiotherapy at chest, extremities….. Plavix 300 mg stat dose and then 75mg/ Qd Atorvastatin 40 mg/Qhs

Case 3 A case of 72 y/o male with headache, lt homonymous hemianopia, from 2 days ago BP:160/90 BS: 120 ECG: Fibrillation Rhythms HB:20 Hct:57 PMHx: Heavy Smoker, AF, HLP( LDL 135, HDL 35)

A B C D approaches Please phlebotomy 1 bag and replacement with normal saline IV fluid Normal saline for rehydration Check Hct /Qd for optimal <55 You should decided for starting anticoagulant (warfarin) ASA 325 mg /stat dose and 80 mg /Qd , unless at Aspirin failure you should ordered Plavix 300mg stat dose and 75 mg /Qd Atorvastatin 40mg/Qhs for LDL Goal: <70

Case 4 A case of 55 y/o male with suddenly confusional statelt t sided weakness , abnormal gaze to right side, dysarthria from 2 days ago… BP: 210/120 BS: 180 T:38.8 TTE(EF):25% Na:125 PMHx: HF, HTN, HLP, controlled DM2

A B C D approaches Position: flat for 24 hours and then at 30◦ (attention to pulmonary edema) Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex) NPO for 24 hours and reevaluation again. Heart monitoring & pulse oximetry Iv fluid therapy normal saline ? Save BP < ?, with Cardiologist consultation TG,cholestrol,LDL,HDL Physiotherapy at chest, extremities….. Plavix 300 mg stat dose and then 75mg/ Qd ASA 80 mg/Qd Atorvastatin 40 mg / Qhs