chapter 31 stroke. © 2005 by thomson delmar learning,a part of the thomson corporation. all rights...
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Pathophysiology Injury to brain tissue caused by disruption of blood flow Also called a cerebrovascular accident (CVA) Results in loss of body functionTRANSCRIPT
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Chapter 31Stroke
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Pathophysiology Types of Stroke Risk Factors Assessment Management
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Pathophysiology
Injury to brain tissue caused by disruption of blood flow
Also called a cerebrovascular accident (CVA) Results in loss of body function
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Pathophysiology
Advances in treatment Time-sensitive condition
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Types of Stroke
Brain cells depend on oxygen Two types of stroke
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Types of Stroke
Ischemic stroke– Blockage of blood supply– 85% of strokes
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Types of Stroke
Ischemic stroke– Blood vessels narrow– Platelets accumulate– Vessel is blocked
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Embolus can also form elsewhere
and travel to the brain
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Stroke
Ischemic stroke– Severe shock can cause very low
blood pressure– Brain receives no oxygen
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Types of Stroke
Ischemic stroke– Brain cells deprived of oxygen will die in a very
short time– A group of cells that have died is called an infarct– The tissue around an infarct is the penumbra– The penumbra may recover
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Types of Stroke
Transient ischemic attack– Stroke symptoms that resolve spontaneously– Caused by a thrombus– High risk of a stroke
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Types of Stroke
Hemorrhagic stroke– Caused by rupture of a blood vessel in brain– May be from high blood pressure or aneurysm– 15% of strokes
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Types of Stroke
Hemorrhagic stroke– Leaking blood can injure brain tissue– Intracranial pressure may become elevated
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Risk Factors
Vascular disease Diabetes Irregular heart rhythms High blood pressure Previous stroke
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Assessment
Signs and symptoms– Depend on the affected area of brain– Middle cerebral artery is most common
vessel affected– Dysarthria
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Assessment
Signs and symptoms– Headache and ICP– Early diagnosis improves outlook
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Symptoms associated with stroke – Generalized or focal weakness– Paralysis on one side of the body– Paresthesias on one side of the body– Difficulty in speaking
Assessment
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Assessment
Symptoms associated with stroke– Headache– Vomiting– Visual changes– Dizziness
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Assessment
Assess for life threats History Focused neurologic examination
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Assessment
Initial assessment– Assess ABCs– Identify potential life threatening
issues at that point
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Assessment
Focused history– Past medical history– Allergies– Medications taken
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Assessment
Focused history– Obtain history from family, if necessary– The management of stroke is very time sensitive
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Assessment
Focused physical exam– Patient’s mental status– Pupils – Assess for pronator drift– Assess for facial droop– Assess for dysarthria
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Assessment
Focused physical exam– Patient’s mental status– Assess pupils
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Assessment
Focused physical exam– Pronator drift
• A useful way to test for arm weakness
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Assessment
Focused physical exam– Facial droop
• Facial droop indicates facial muscle weakness
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Assessment
Focused physical exam– Dysarthria
• Garbled speech
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Assessment
Focused physical exam– Expressive aphasia– Receptive aphasia– No speech
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Assessment
Focused physical exam– Cincinnati Prehospital Stroke Scale– Other stroke scales
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Assessment
Baseline vital signs– May have high blood pressure
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Management
Recognize and transport Every minute counts
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Management
Hospital management– Diagnosis– Therapy
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Management
Hemorrhagic stroke– Control blood pressure
Ischemic stroke– Medications
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Management
Stroke centers Timely transport
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Management
Specific management of all stroke patients includes:– ABCs– High-flow 100% oxygen– Support blood pressure– Elevate head of bed
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Other diagnoses to consider in presence of stroke-like symptoms:– Hypoglycemia– Bell’s palsy– Traumatic brain injury
Management
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Management
Other diagnoses to consider in presence of stroke-like symptoms:– Seizure– Migraine– Drug toxicity
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Transport– To most appropriate hospital– ALS intercept– Notify hospital
Management
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Management
Ongoing assessment– Note carefully any changes
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Stop and Review
Describe the pathophysiology of ischemic stroke.
Describe the pathophysiology of hemorrhagic stroke.
Identify several conditions that might mimic stroke.