1. S TROKE M ANAGEMENT A CCORDING TO B EST P RACTICE ……..it matters…….. 1

2. What can I do??? Manage TIA and Stroke According to Best Practice Guidelines Implement care practices that will minimize complications 2

3. Let’s discuss potential secondary complications… Venous thromboembolism Mobilization Temperature Blood glucose abnormalities Continence Dysphagia 3

4. DVT or PE Venous thromboembolism prophylaxis High risk to develop a DVT or PE are those who are unable to move one or more limbs or unable to mobilize independently Early mobilization, compression stockings Pharmaceutical prophylaxis 4

5. Mobilization Early Mobilization “The act of getting a patient to move in bed, sit up, stand and eventually walk” All stroke patients should be mobilized as early and frequently as possible- preferably within 24 hours 14% of stroke patients develop pressure ulcers 5

6. Factors Affecting Infarct Size: Body Temperature Temperature Control An increased temperature is associated with increased morbidity and mortality as it increases neuronal ischemic injury Monitor as part of vital signs 6

7. Factors Affecting Infarct Size: Hyperglycemia Hyperglycemia Associated with worse stroke outcomes Increased anaerobic metabolism Increased lactic acid production Progression of ischemic penumbra to frank infarction 7

8. UTI Avoid indwelling catheters Better to do intermittent catheterization Ensure adequate fluid intake Monitor signs & symptoms of UTI 8

9. Prevention of Complications: Dysphagia Dysphagia and Aspiration: 40% acute stroke patients affected Significant contributor to stroke morbidity and mortality (aspiration pneumonia, mal nutrition, enteral feeds) Bedside screening must be done (may need modified barium swallow with people that aspirate silently) Consult with SLP 9

10. In-hospital Stroke Canadian Study: “ Patients who have a stroke while in hospital are less likely to benefit from rapid access to acute stroke care than those who come into the emergency room with the same condition” Know the signs and symptoms and who to call This is an Emergency 10

11. Medical Management 1. Antiplatelet 2. Antihypertensive 3. Statin Goal: Minimize plaque formation Stabilize existing plaque 11 Triple Therapy

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13. Time is Brain THETREATMENTWINDOW for thrombolytic therapy is 4.5 hours 4.5 hours

14. N ORMAL CT I NTRACEREBRAL B LEED 14

15. I SCHEMIC S TROKE 15

16. Ischemic Stroke-Etiology Large Vessel Disease Atherosclerosis Small Vessel Disease Lacunar infarction Cryptogenic Cardioembolic 16

17. Hemorrhagic Stroke - Etiology 17 Primary Chronic hypertension Anticoagulant /platelet therapy Drug use Other bleeding disorders Secondary Vascular malformations Tumors

18. Stroke Mimics Postictal seizure Systemic infections Tumour/ abscess Metabolic disturbance hypoglycemia Bell’s palsy Old stroke Confusion Head trauma 18

19. In-hospital Stroke Canadian Study: “Patients who have a stroke while in hospital are less likely to benefit from rapid access to acute stroke care than those who come into the emergency room with the same condition” Know the signs and symptoms and who to call This is an Emergency 19

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