Stroke by siva

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Stroke:

Stroke Prepared & Presented by Dr. Siva Reddy Challa, Professor & HOD, Dept. of Pharmacology KVSR Siddhartha College of Pharmaceutical Sciences, Siddhartha Nagar, Vijayawada-520010 Andhra Pradesh, INDIA Email: sivareddypharma@gmail.com

What is a stroke or TIA?:

What is a stroke or TIA? Stroke- Sudden onset of focal neurologic deficits fitting a vascular distribution TIA Stroke-like symptoms lasting <1 hr and completely resolve Most TIAs last 15-30 minutes

Details of Facial Droop:

Details of Facial Droop

PowerPoint Presentation:

Details of Arm Drift

Time dependent treatment:

Time dependent treatment IV t-PA must be given within 3 hours from onset of symptoms or from “time last seen normal” Intra-arterial (IA) therapy must be given within 6 hours 3 hours

Thrombolytic Therapy for Acute Ischemic Stroke:

Thrombolytic Therapy for Acute Ischemic Stroke < 3 hours IV t-PA IA t-PA 3-6 hours Onset of Symptoms Therapy

Acute Management: History:

Acute Management: History Symptom onset or time last seen normal Correlate times (alarms, work, drive time TV) Corroborate with witness Prodromal or previous symptoms/TIAs Exclude stroke mimics (seizure,migraine hypoglycemia, orthostasis)

Is the patient a thrombolytic candidate?:

Is the patient a thrombolytic candidate? Onset < 6 hrs CT negative for hemorrhage Not anticoagulated (INR < 1.5)  Keep BP < 220/120  ASA 325mg chewed  DVT prophylaxis -Heparin 5000 SQ BID NO YES  Keep BP <185/110  < 3 hrs -IV tPA  3-6 hrs -Intra-arterial t-PA

Blood Pressure Management in Acute Ischemic Stroke:

Blood Pressure Management in Acute Ischemic Stroke No thrombolytics Thrombolytics BP >220/120 MAP>130 requires Labetalol 10-30 mg IV q 10-15min Enalapril 0.625-1.25 mg IV q 6-8hrs prn Nitroprusside 0.5-1.0 µg/kg/min cont. IV Nicardipine 2.5-15 mg/hr continuous IV DBP> 140 Nitroprusside 0.5-1.0 µg/kg/min cont. IV Nicardipine 2.5-15 mg/hr continuous IV BP > 185/110 Nitropaste 1-2 inches Labetalol 10-30 mg IV q 10-15min Enalapril 0.625-1.25 mg IV q 6-8hrs (watch for angioedema )

Fibrinolytic therapy use :

Fibrinolytic therapy use

AHA Stroke Levels of Evidence:

AHA Stroke Levels of Evidence Level I: Data from randomized trials with low false-positive (alpha) and low false-negative (beta) errors Level II: Data from randomized trials with high false-positive (alpha) or high false-negative (beta) errors Level III: Data from nonrandomized concurrent cohort studies Level IV:Data from nonrandomized cohort studies using historical controls Level V: Data from anecdotal case series

AHA Stroke Strength of Recomendation:

AHA Stroke Strength of Recomendation Grade A:Supported by Level I evidence Grade B:Supported by Level II evidence Grade C:Supported by Levels III, IV, or V evidence

Thank You This presentation is dedicated to my students:

Thank You This presentation is dedicated to my students

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