Medical management of ABI

up to… of strokes are preventable due to lifestyle factors

80%

Diet modification to prevent stroke

increase fruits and vegetables, decrease saturated and trans fat and salt

BMI for stroke prevention

<25

lipoprotein A may be more associated with

cardiac/stroke problems

A1c levels for stroke prevention

<6.5

heart conditions predisposing for stroke

coronary heart disease, atrial fibrillation

Cholesterol levels for stroke prevention

total <200, LDL<100, HDL >60, triglycerides <150

Total cholesterol level for stroke prevention

<200

LDL level for stroke prevention

<100

HDL level for stroke prevention

>60

Triglyceride level for stroke prevention

<150

Blood pressure limit to prevent stroke

<140/90 or <130/80

Secondary prevention blood pressure limit

<130

Scale used to classify severity of stroke

National institutes of health stroke scale (NIHSS)

NIHSS 0

no stroke symptoms

NIHSS 1-4

Minor stroke

NIHSS 5-15

Moderate stroke

NIHSS16-20

Moderate to severe stroke

NIHSS 21-42

severe stroke

Components of NIHSS

Level of consciousness questions and commands, gaze, visual field, facial palsy, motor of arm and leg, limb ataxia, sensory loss, aphasia, dysarthria, inattention and extinction

CTA is good when looking for

an aneurysm

TPA

tissue plasminogen activator

TPA must be administered within

3-4.5 hours

Brand names for TPA

Activase, alteplase

Complications associated with TPA

decreased BP and hemorrhage

TPA works by

converting plasminogen to plasminogen which dissolves fibrin in the clot

Mechanical thrombectomy is performed within… of symptom onset

6 hours

Retrieval technique in mechanical thrombectomy is dependent on

clot type (cardioembolic v. thrombolytic)

Catheterization procedures are usually reserved for

large vessel occlusion (ICA or MCA)

If the clot came from somewhere else it is

embolic

Hemorrhagic stroke treatments

BP control, end-vascular procedures, surgical interventions

BP control for hemorrhagic stroke

keeping it in a spot where it can perfuse, but low enough that there’s not as much bleeding

Endovascular procedures for hemorrhagic stroke

coiling, flow diversion, gluing

Risk of gluing to treat hemorrhagic stroke

glue dislodging and causing ischemic stroke

ABI

Acquired brain injury

Surgical interventions for hemorrhagic stroke

craniotomy, craniotomy, clipping

Medical monitoring components in stroke treatment

Neurologic status via repeat NIHSS, BP, glucose, temp, O2, dysphagia, nutrition, secondary complication prevention

TBI prevention

motor vehicle safety, fall prevention programs, violence prevention, sports safety initiatives

standardized tools for mild TBI

Acute concussion evaluation (ACE), Sports Concussion Assessment Tool 6 (Scat 6)

Mild TBI evaluation

symptom checklist, focused neurological examination, standardized tools

signs of concussion

headache, dizzy, sluggish, bothered by light/noise, vomiting or nauseous, double or blurry vision, confusion, trouble focusing or remembering, feeling emotional/down, sleep problems

Treatment components for mild TBI

education and reassurance, correct amount of physical and cognitive rest (not doing nothing), gradual resumption of activity (duration and intensity)

Moderate TBI evaluation

GCS for initial assessment for triage, neuroimaging (non-contrast CT, MRI, DTI)

DTI looks at

white matter and can pick up axonal injury

GCS

Glasgow coma scale

moderate-severe TBI treatment goals

manage symptoms level functions to prevent secondary cell death

ICP intended range for moderate to severe TBI pt

<22 mmHg

glucose target range for moderate to severe TBI pt

100-180 mg/dL

Tier 1 Management of ICP

HOB elevated >30°, sedation and analgesia, intermittent ventricular drainage

Tier 2 ICP management

intermittent CSF drainage, hyperosmolar therapy (mannitol, hypertonic saline)

Mannitol and hypertonic saline work as an

osmotic gradient to pull H2O from brain to blood

Tier 3 ICP Management

Decompressive therapy (craniotomy/ectomy), continuous neuromuscular blocking agents, pharmacological coma, hypothermia

moderate-severe tbi treatment focuses on

life saving interventions

aims of moderate-severe TBI treatment

Respiratory intervention, nutritional supplementation, prevention of secondary complication