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Neurological Emergencies-Stroke PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Neurological emergencies: stroke".
This medical PowerPoint presentation talks about stroke as a serious neurological emergency.
A stroke is a serious neurological emergency that occurs when blood flow to the brain is interrupted or reduced, leading to brain cell damage and death. The severity of a stroke can vary depending on the location and extent of the damage, as well as how quickly treatment is received.
There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic strokes occur when a blood vessel in the brain becomes blocked, usually by a blood clot, while hemorrhagic strokes occur when a blood vessel ruptures and bleeds into the brain.
Treatment for stroke typically involves restoring blood flow to the brain as quickly as possible. This may involve the use of clot-busting medications or procedures such as mechanical thrombectomy. Rehabilitation may also be necessary to help patients regain lost function and improve their quality of life.

Tags : stroke, neurological emergency, ischemic stroke, hemorrhagic stroke, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 1484 | Downloads : 2

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Slide 1-

Neurological emergencies:stroke
Slide 2-

What is a stroke? “Neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours.” - WHO Death or injury of brain tissue from oxygen deprivation.
Slide 3-

Stroke Facts A stroke is a medical emergency! Approximately 795,000 each year in the US, 5th leading cause of death (133,000) 2nd most frequent cause of death world-wide (>6M) 5th leading cause of death in the US A leading cause of adult disability On average, someone in the US has a stroke every 40 seconds Over 4 million stroke survivors in the US Crosses all ethnic, racial, and socioeconomic groups Direct and indirect cost of stroke annually in US: $38.6 Billion (2009)
Slide 4-

Types of Stroke Ischemic (87%) Thrombosis Embolism Systemic hypoperfusion (shock) Cerebral Venous Sinus Thrombosis (CVST) Hemorrhagic (13%) Intracerebral Subarachnoid
Slide 5-

CVA vs TIA TIAs are strokes where symptoms last less than two hours. “mini-stroke” Caused by small clots Complete resolution typically occurs without further treatment within 24 hours About 15% of all strokes (CVAs) occur after a TIA TIA is a medical emergency – even if symptoms have resolved CVAs are strokes where symptoms are typically persistent until treated by medical professionals. ASA recommends terminology changes - “Brain Attack”
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Risk Factors Controllable Hypertension (35-50% of stroke risk) (decrease 10 mmHg Systolic or 5mmHg Diastolic reduces risk ~ 40%) Hyperlipidemia (high cholesterol) Diabetes (2 to 4x multiple) Tobacco Use (2 to 4x multiple) Alcohol Use Physical Inactivity (decrease risk 30m/5d/wk) Obesity Heart Disease Atrial Fibrillation Pregnancy Non-controllable Age Increases exponentially from 30 95% > 45 YO 67% > 65 YO Gender Women are at higher risk 60% of stroke deaths are women Race South Asian (40%) African American Family History and Genetics Previous Stroke or TIA
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Signs / symptoms Hemiparesis – one-sided weakness (very common) Aphasia – difficulty speaking or inability to speak Headache – caused by hemorrhage (less common, but very important) Confusion or Altered Mental Status Dizziness Numbness, weakness, or paralysis – usually on one side of the body Loss of bladder and/or bowel control
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Signs / symptoms Impaired vision or loss of vision in one eye Hypertension Dyspnea – difficulty breathing or snoring respirations Nausea or vomiting Seizures Unequal pupils Unconsciousness (uncommon)
Slide 9-

Common stroke symptoms Left hemisphere stroke Speech problems – what is being said or inability to get words out Problems with comprehension Left gaze preference Weakness or numbness of right face, arm, or leg Right hemisphere stroke Dysarthria – slurred speech Left sided neglect Right gaze preference Weakness or numbness of left face, arm, or leg
Slide 10-

Common stroke symptoms Brainstem stroke symptoms Nausea, vomiting, or vertigo Speech problems Dysphasia - swallowing problems Abnormal eye movements Decreased consciousness Crossed findings Silent strokes Asymptomatic Statistically significant Only detected by MRI
Slide 11-

Common stroke symptoms Intracerebral hemorrhage Nausea and Vomiting Headache One sided weakness Decreased consciousness Subarachnoid hemorrhage Worst headache of life Intolerance to light Neck stiffness or pain
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Common stroke mimics Alcohol intoxication Cerebral infections Drug overdose / toxicity Epidural hematoma Hypoglycemia Metabolic disorders Migraines Neuropathies (Bell’s Palsy) Seizure and post seizure, Todd’s Paralysis Brain tumors Hypertensive encephalopathy
Slide 13-

Early recognition of strokes BE-FAST! Balance – Loss of balance, headache, or dizziness Eyes – Blurred vision or loss of visual fields Face – One side of the face drooping Arms – Arm or leg weakness Speech – Difficulty speaking or forming words Time – Time is brain – seek treatment immediately!
Slide 14-

Patient assessment(2019 MARYLAND Medical Protocols) Initiate General Patient Care Scene Size-Up Primary Assessment Secondary Assessment Perform glucometer check as part of vital sign assessment. Perform Stroke Assessments The Cincinnati Prehospital Stroke Scale Posterior Cerebellar Assessment If the Cincinnati Prehospital Stroke Scale OR the Posterior Cerebellar Assessment is POSITIVE perform the Los Angeles Motor Scale (LAMS).
Slide 15-

Patient assessment(2019 MARYLAND Medical Protocols) Cincinnati Prehospital Stroke Scale Facial Droop (have patient show teeth or smile) Normal – both sides of face move equally Abnormal – one side of face does not move as well as the other side Arm Drift (patient closes eyes and holds both arms straight out for 10 seconds) Normal – both arms move the same or do not move at all Abnormal – one arm does not move or one arm drifts down compared to the other Abnormal Speech (have the patient say “you can’t teach an old dog new tricks”) Normal – patient uses correct words with no slurring Abnormal – patient slurs words, uses the wrong words, or is unable to speak
Slide 16-

Patient assessment(2019 MARYLAND Medical Protocols) Posterior Cerebellar Assessment (NEW 2019) Balance and Eyes Sudden onset of loss of balance or dizziness Sudden vision loss (including intermittent loss or blurred vision) Other symptoms may include: Contralateral sensory deficits (occasionally accompanied with motor deficits) Alexia without agraphia (able to write but not read)
Slide 17-

Patient assessment(2019 MARYLAND Medical Protocols) Los Angeles Motor Scale (LAMS) Facial droop Absent – 0 Present – 1 Arm drift Absent – 0 Drifts down – 1 Falls rapidly – 2 Grip Strength Normal – 0 Weak grip – 1 No grip – 2
Slide 18-

Patient assessment(2019 MARYLAND Medical Protocols) Strokes during pregnancy or shortly after giving birth are rare – but a significant increase recently. Fibrinolytic checklist is NO longer used for stroke patients (2017)
Slide 19-

Patient Treatment(2019 MARYLAND Medical Protocols) Do not administer aspirin Position patient with head elevated at 30 degrees If patient has a positive Posterior Cerebellar Assessment OR Cincinnati Prehospital Stroke Scale AND can be delivered to the hospital within 20 hours of last known well time: Patient is Priority 1 – notify receiving facility with “Stroke Alert with a last known well time of XX:XX” ASAP! Transport patient to closest Acute Stroke Ready, Primary, or Comprehensive Stroke Center If no stroke center with 30 minutes, go to the nearest hospital Consider aeromedical transport Obtain and document a contact telephone number for one or more individuals who have details about the patient’s medical history – this must be provided to the receiving facility.
Slide 20-

Patient Treatment(2019 MARYLAND Medical Protocols) Administer oxygen at 2-6 lpm via NC unless hypoxic or in respiratory distress Use glucometer and treat accordingly if glucose is less than 70 mg/dl ALS Interventions include: Establish IV access with Lactated Ringers Consult if patient is hypotensive Consider obtaining blood sample using closed system Do not treat hypertension in the field
Slide 21-

Pediatric patients (under 18)(2019 MARYLAND Medical Protocols) Stroke is uncommon but does occur. Most often caused by: Congenital Heart Defects Infections (including Chicken Pox, Meningitis, or Encephalitis) Brain Injury Blood Disorders (such as Sickle Cell Disease) Most often seen in infants, but can occur at any age Consult with Pediatric Base Station, arrange transport to a Pediatric Trauma Center. Johns Hopkins Children’s Center, Baltimore Children’s National Medical Center, DC
Slide 22-

Acute ISCHEMIC stroke hospital Treatment options IV-tPA – Tissue Plasminogen Activator “clot-buster” (alteplase) Patient must be within the time window of 3.5 hours (4.5 hours for some patients) Intra-arterial Thrombolysis Doctor uses a catheter to administer tPA directly into the clot Treatment can be administered up to 6 hours from symptom onset Patients must meet strict criteria Mechanical Thrombectomy Uses a device to retrieve the clot Treatment can be administered up to 8 hours from symptom onset If IV-tPA fails or patient is ineligible, they may be eligible for mechanical thrombectomy
Slide 23-

stroke Centers Acute Stroke Ready Acute Stroke Team available 24/7, at bedside within 15 minutes No designated beds for acute care of stroke patients Neurosurgical Services available within 3 hours Telemedicine available within 20 minutes of it being necessary IV thrombolytics and transfer of patients who have received IV thrombolytics for medical management of stroke to PSC OR CSC
Slide 24-

Stroke Centers Primary Stroke Center Acute Stroke Team available 24/7, at bedside within 15 minutes Stroke unit or designated beds for acute care of stroke patients Neurosurgical Services available within 2 hours or available 24/7 if provided on site Telemedicine available if necessary IV thrombolytics and medical management of stroke
Slide 25-

Stroke Centers Comprehensive Stroke Center Acute Stroke Team available 24/7, at bedside within 15 minutes Dedicated neuro intensive care beds for complex stroke patients with on-site neurointensivist 24/7 24/7 availability of Neurointerventionist, Neuroradiologist, Neurologist, Neurosurgeon Telemedicine available if necessary IV thrombolytics, full range of neurological procedures, and medical management of stroke
Slide 26-

MIEMSS Designated Stroke Centers Acute Stroke Ready (1) Garrett County Memorial Hospital, Oakland Primary Stroke Centers (35) Western Maryland Health System, Cumberland Meritus Medical Center, Hagerstown Frederick Memorial Hospital, Frederick Comprehensive Stroke Centers (3) Johns Hopkins Bayview Medical Center, Baltimore The Johns Hopkins Hospital, Baltimore University of Maryland Medical Center, Baltimore
Slide 27-

NATIONALLY RECOGNIZED STROKE CENTERS About 1600 recognized stroke facilities, including: Acute Stroke Ready Hospital – approximately 70 Primary Stroke Centers – approximately 1,000 Comprehensive Stroke Centers – approximately 175 WVU, Morgantown WV UPMC, Pittsburgh PA UPMC Shadyside, Pittsburgh PA AHN, Pittsburgh PA UVA, Charlottesville VA
Slide 28-

recovery Rehab can be inpatient, outpatient, or a combination Various rehab programs depending on need, including: Physical Therapy Occupational Therapy Speech-Language Therapy Patient / Family Education Support Groups
Slide 29-

Reducing risk of additional strokes Maintain a healthy blood pressure – ideally below 120/80 Maintain healthy blood sugar and cholesterol levels Address other health issues, especially atrial fibrillation and sleep apnea Adopt healthy lifestyle habits, including diet and physical and mental exercise Limit or eliminate alcohol, tobacco, and vaping Maintenance medications may be required, such as aspirin, depending on stroke type
Slide 30-

Questions ?
Slide 31-

Sources American Stroke Association (www.strokeassociation.org) MIEMSS 2019 Maryland Medical Protocols (www.miemss.org) Western Maryland Health System Stroke Center (www.wmhs.com) The Joint Commission [formerly JCAHO] (www.jointcommission.org) Wikipedia (www.wikipedia.org)