Ischemic stroke early assessment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

The early assessment of stroke includes airway, breathing and circulation assessment even befor the patient is transferred to the stroke unit or hospital. Once patient is hemodynamically stable, further management is directed towards determining the underlying cause and appropriate treatment plan.[1]

Early assessment

The initial assesment goals of ischemic stroke may include the following. [1]


 
 
 
 
 
 
 
 
 
 
 
 
1) Airway

2) Breathing

3) Circulation
 
1) O2 administration at SpO2<94%

2) Ventilatory assisstance is provided to patients who have difficulty breathting

3) IV fluids or vasopressors are given to maintain hemodynamic stability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Early Diagnosis
 
History and PE

1) Help assess the severity of neurological deficit
2) Give clue to the underlying cause

3) Determine the site of infarction
 
Initial diagnostic tests

1) Noncontrast brain CT or brain MRI
2) Blood glucose
3) Oxygen saturation
4) Serum electrolytes/renal function tests
5) Complete blood count, including platelet count
6) Markers of cardiac ischemia
7) Prothrombin time/INR
8) Activated partial thromboplastin time

9) ECG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Early assessment of ischemic stroke
 
 
 
 
Reperfusion therapy
 
Medical
r-tPA in eligible patients within 3-4.5 hours of onset of symptoms
 
Surgical
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symptomatic relief
 
1) Fever
2) Headache
3) Shortness of breath
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prognosis
 
1)NIHSS scoring
2)Glassgow coma scale
 
 
 
 
 
 

References

  1. 1.0 1.1 Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.

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