Time Goals Stroke
10 minutes
Assess ABC's, Provide oxygen if needed, obtain IV access, Check glucose, neuro screening, activate stoke team, Order CT (or MRI), Obtain 12-lead
What are the three components of the Cincinnati Prehospital Stoke Scale?
/
Facial Droop, Arm Drift, Abnormal Speech
What are the first line drugs to lower BP? What are their doses?
Labetalol 10-20mg IV over 1-2 minutes, may repeat once or...
Nicardipine IV 5mg/hour, titrate up by 2.5mg/hour every 5-15 minutes. Max 15mg/hour
Oxygen threshold? First line therapy
<90%
Start oxygen at 4L/min
25 Minutes
Neurologic assessment by stroke team, patient history, Establish time of onset
Maintain supplementary oxygen at what %?
94% or better
If not given by EMS what can be chewed my the patient and how much?
Aspirin 160-325mg
45 Minutes
CT results (hemorrhage or no hemorrhage)
What is important about the CT scan and treatment?
Non-contrast to determine if the stroke is hemorrhagic or not.
NO aspirin, heparin, or tPA before
This is given for chest discomfort first Line? What is the dose and how many times can it be given?
Nitro
.4mg and it can not be given more then 3 times in 15 minutes
60 Minutes
Administer fibrinolytic therapy, if not a candidate give aspirin
Why is the EKG important?
Monitor for first 24 hours
What are the contraindications for Nitro?
Inferior wall MI and RV infarction
Hypotension SBP <90mmHg
Bradycardia HR <50
Phosphodiesterase Use
3 hours
Get them into a monitored bed
administer fibrinolytic treatment from time of onset of symptoms... 4.5 hours in some patients
What are the 8 D's of stroke Care?
Detection, Dispatch, Delivery, Door, Data, Decision, Drug/Device, Disposition
What opiates can be affective for pain control? Dose?
Morphine 2-10mg IVP
6 hours
Administer endovascular therapy
What is the BP threshold for tPA use?
Must be lower than 185/110
What can you do as in the terms of aspirin if they have had recent Peptic ulcer or NV? Dose
300mg ASA suppository