Medical Emergencies Ch. 19-20

cerebrovascular accident

defined as any vascular injury that reduces cerebral blood flow to a specific region of the brain, causing neurologic impairment

cva

Over half of survivors are left with a permanent disability or need assistance with daily life

cva

AKA: stroke & brain attack

elevated bp

The major risk factor for CVA is:

occlusive

CVA caused by a blockage

hemorrhagic

CVA caused by bleeding - a defect or rupture

occlusive

Lacunar infarction, Cerebral infarction, and Transient ischemic attack (TIA)

are part of which classification of CVA?

hemorrhagic

Intracerebral and Subarachnoid

are part of which classification of CVA?

lacunar infarction

Associated with poorly controlled hypertension & diabetes

Prognosis for recovery is good, partial or complete; recovery in 4 – 6 weeks

cerebral infarction

Most prevalent form of CVA (87%)

Caused by atherosclerotic disease & cardiac abnormalities

transient ischemic attack

Aka: Mini stroke

Defined as a neurologic deficit that has complete clinical resolution w/in 24 hours

intracerebral hemorrhage

Cause may be an acute change or elevation of systolic BP

Persons older than 50 with history of HBP

subarachnoid hemorrhage

Usually occurs when an aneurysm ruptures as a result of weakened vessel walls at arterial bifurcation

Does not have risk factor of HBP

prevention

Medical history questionnaire, dialogue history, physical exam & monitoring vital signs

Recognition of predisposing risk factors: HBP and diabetes

prevention

A patient with ASA 3 who has had CVA warrants medical consult prior to treatment

asa 4

Any adult patient with BP of 200 mm Hg systolic or 115 mm Hg diastolic or above should not receive elective dental treatment

clinical manifestations of cva

The onset of symptoms may be sudden, slow, violent or minimal impairment

Results may be transient or permanent loss of neurologic function

clinical manifestations of cva

Headaches, Dizziness & vertigo, Drowsiness, Sweating & chills, Nausea & vomiting, Weakness, paralysis & speech difficulties

fast

CVA/STROKE WARNING signs and symptoms mnemonic

face drooping, arm weakness, speech difficulty, time to call 911

What does the FAST mnemonic stand for

diagnostic clues of cva

Hypertension, Altered consciousness, Neurologic signs and symptoms

supine

What position must we never put patients in, that have a CVA

semi-fowler position

Correct patient position for cva

Patient at about 45 degress

management

If s & sx resolve (TIA) pt should not drive them self.

If CVA, s & sx do not resolve, transport to hospital

6

Do not treat patient for _ months after CVA

2-10 minutes

How long do symptoms of a transient ischemic attack last

cva

For this emergency, signs and symptoms don’t get better with time