+ Stroke Chapter 24

+ Stroke Cereberovascular Accident Fourth leading cause of death in US Number one cause of long-term disability Estimated that 1 in 17 deaths are caused by stroke

+ Stroke- rapid or gradual nonconvulsive neurologic deficit that affects a vascular territory and results in local focal deficit. Ischemic (87%) & Hemorrhagic 700,000 new/repat cases/yr RF- smoking, high cholesterol, HF, Afib, DM, obesity

+ Stroke Assessing time of onset of symptoms Complete neuro assessment PMH Diagnostics- Treatment- ABC’s - fibrinolytics,meds,

+ Assessment- HPI- pain, provoking factor, food/activity, associated symptoms. PMH- meds, preexisting illness. Exam- LOC, temp, rash Diagnostic- labs, xray, CT, EEG, LP Management/evaluation-

+ Cincinnati Prehospital Stroke Scale

+ Los Angeles Pre- Hosp Stroke Scale

+ NIHHS Stroke Scale

+ Treatment Which patients are candidates for fibrinolytics? New “Stroke Centers” 7 D’s DetectionDispatchDeliveryDoor DataDecisionDrug

+ Ischemic Stroke 87% of all strokes Include thrombolytic stroke, embolytic stroke, TIA A-fib is a high risk factor for cardioembolic stroke Need S/S less than 3 hours for fibrinolytics

+ Hemorrhagic Stroke 13% of all strokes Intracerebral hemorrhagic stroke 10% Hypertension is most common cause Subarachnoid hemorrhagic stroke 3% Common causes are aneurysm and AVM