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Stroke CVA TIA | Neurological Emergencies

Stroke (Cerebrovascular accident -CVA) and Transient Ischemic Attack (TIA): Stroke (CVA) results from interruption of circulation to the brain causing ischemia and damage to brain tissue. Neurological symptoms persist longer than 24 hours. Recovery takes place in weeks to months.

Two types:
Occlusive: 3 out of 4 strokes, caused by blockage in a blood vessel
Hemorrhagic: caused by bleeding in the brain. Symptom abrupt and severe

Clot Busters: Occlusive strokes only! Must be within 6 hours. Most wake up in the am when it is too late.
Ischemic penumbra: area of tissue potentially viable surrounding the infarct zone. Cocaine is becoming the most common cause of stroke in young people

Assessment (Stroke): Most common finding is paralysis. Usually hemiplegia, damage on one side of brain affects opposite side of the body. Most have elevated BP. Also seizures, dizziness, loss of consciousness, stiff neck, headache, altered LOC, airway problems, hypoventilation, cardiac dysrhythmias. My favorite: vomiting. Pupillary abnormalities.

Cincinnati Prehospital Stroke Scale:
Facial Droop: show teeth or smile
Arm Drift: close eyes and hold arms out
Speech: you can’t teach an old dog new tricks

Management:
Establish and maintain the airway, provide hi-flow O2 by mask. Consider intubation if necessary
Nothing by mouth, prepare for vomit
Reassure patients
Start an IV
Cardiac monitor
Measure blood glucose

TIAs: mini-strokes: stroke-like neurological deficits that resolve within minutes to hours. They still should be evaluated at the hospital, because they are at risk for stroke.

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