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Published byCory Hopkins Modified over 9 years ago
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Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) July 2008
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Face - weakness? Arm - weakness? Speech - problems? Test – Time to call 999 Exclude Hypoglycaemia as cause ROSIER score in A+E
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Assess swallow Early mobilisationGive aspirin 300mg Screen for malnutrition Admit to stroke unit Thrombolysis Immediate imaging Imaging asap Acute stroke confirmed
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Perform immediately if Indications for thrombolysis or early anticoagulation treatment On anticoagulant treatment A known bleeding tendency Depressed GCS Unexplained progressive or fluctuating symptoms Papilloedema, neck stiffness or fever Severe headache at onset of symptoms Otherwise perform asap
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Exclude intracranial haemorrhage Should be given within 3 hours of symptom onset Access to imaging and re-imaging Should be administered within a stroke service Consider BP reduction <185/110 in people who are candidates for thrombolysis
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Assess swallow on admission prior to administration of food, fluids or oral medications Screen for malnutrition using validated tool - MUST Consider NG tube feeding within 24 hours
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Encourage and support sitting up asap Mobilise as soon as possible
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300mg aspirin asap within 24 hours Continue aspirin for 2 weeks after stroke and then initiate long-term antithrombotic treatment Do not start statin treatment immediately after an acute stroke Continue statin treatment in those who are already taking statins
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Start daily aspirin 300mg immediately Introduce measures for secondary prevention once diagnosis is confirmed Assess risk of subsequent stroke – ABCD2
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High risk of stroke: ABCD2 4 or more Crescendo TIA Specialist assessment within 24 hrs If vascular territory or pathology uncertain for urgent brain imaging Lower risk of stroke: ABCD2<3 1 week after symptoms resolved Specialist assessment within 1 week If vascular territory or pathology uncertain refer for brain imaging
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