Downloaded 17 times
More Related Content
![Management of acute ischemic stroke including tia [autosaved]](https://cdn.slidesharecdn.com/ss_thumbnails/managementofacuteischemicstrokeincludingtiaautosaved-180808183403-thumbnail.jpg?width=640&height=640&fit=bounds)
![Mechanical thrombectomy in acute stroke [Autosaved].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/mechanicalthrombectomyinacutestrokeautosaved-230102142009-fe15766f-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Acute thrombolysis in Stroke PPT Dr Jankar copy.
Acute thrombolysis in Stroke PPT Dr Jankar copy.
- 1. Acute Stroke Protocoland Thrombolysis in Stroke By: Dr. Rahul Jankar Specialist: Neurology MBBS, MD, DM (NIMHANS) AIMS hospital Dombivli.
- 2. Importance of Doorto Needle time: Simplifying Treatment Protocols
- 3. Canadian Stroke Strategy2011. Paramedic Prompt Card; Issue 110. The situation at large First medical contact is physician The earlier treatment is initiated, the better the outcome Diagnosis requires stroke expertise Treatment carries a risk and requires monitoring Thrombolysis is underused Resources are often limited !
- 4. How are strokesclassified? Ischaemic stroke The blood supply to an area of the brain is completely blocked, causing tissue death and neurological damage Transient ischaemic attack (TIA) The blood supply to an area of the brain is temporarily interrupted but is restored within 60 min and the patient returns to normal Haemorrhagic stroke Bleeding in the brain can prevent the normal flow of blood to the tissue beyond the damage and causes neurological symptoms ISCHAEMIC STROKE IS THE COMMONEST FORM OF STROKE A stroke can be due to a blockage in one of the arteries (ischaemic stroke) or bleeding in the brain (haemorrhagic stroke)
- 5. FAST is themost commonly used stroke screening tool
- 7. Stroke- an Emergency ActFAST Time is still a Brain......
- 8. Evidence for DTNtime
- 9. ED response times NINDSrecommendations Door-to-MD 10 minutes Door-to-Stroke Team Notification Door-to-CT Scan 25 minutes Door-to-Needle (80% threshold) Door-to-Admission 3 hours 15 minutes 60 minutes ED, Emergency Department Bock. NINDS Stroke symposium proceedings 1996; Updated 2011.
- 10. Factors associated withDTN time
- 11. Why DTN is<60 minute?
- 12. NIHSS Scale Monitoring andquantification
- 13. What is theNIHSS and Why Do We Need It? • Standardized stroke severity scale to describe neurological deficits in acute stroke patients • Allows us to: – Quantify our clinical exam – Determine if the patients’ neurological status is improving or deteriorating – Provide for standardization – Communicate patient status
- 14. The Neurological Examination& NIHSS Neurological Examination • LOC • Mental status and cognitive function • Cranial nerves • Motor system • Sensory function • Cerebellar system (coordination and gait) • Reflexes NIHSS • LOC • Best gaze • Visual field testing • Facial paresis • Arm & leg motor function • Limb ataxia • Sensory • Best language • Dysarthria • Extinction & inattention
- 15. NIHSS and PatientOutcomes • Total scores range from 0-42 with higher values representing more severe infarcts – >25 Very severe neurological impairment – 15-24 Severe impairment – 5-14 Moderately severe impairment – <5 Mild impairment Adams, HP, et al. (1999). Neurology: 53: 126-131. • A 2-point (or greater) increase on the NIHSS administered serially indicates stroke progression. It is advisable to report this increase.
- 16. Online NIHSS Certification •Online NIHSS Certification available free through the American Stroke Association. • The online program provides detailed instructions and demonstration scenarios for practice in scoring the NIHSS. • Certification is completed by scoring different patient scenarios. www.strokeassociation.org
- 17. Acute Stroke Care& IV Thrombolysis
- 18. What has notchanged since IV Alteplase is on the stroke scene Thrombolysis is still underused The majority of patients who receive tPA have a DTN time ≥ 60 min Ongoing effort to overcome delays Reducing rtPA treatment times is the single most important modifiable factor to improve patient outcomes from hyper-acute stroke care rt-PA for Stroke Treatment 1995-2015
- 19. What is rtPA? •rtPA is a thrombolytic drug also known as Alteplase – Used for Acute Ischemic Stroke (AIS), AMI, PE. – The dosage for AIS is less than the dosing for AMI or PE • rtPA disrupts the integrity of a thrombus, plaque or emboli within a blood vessel – Other Thrombolytics had unacceptably high hemorrhage rates or were not tested extensively to establish risk versus benefits.
- 20. Treat the patientwith Actilyse® Boehringer Ingelheim. Actilyse® Summary of Product Characteristics In acute ischaemic stroke, the recommended dose of Actilyse® is 0.9 mg/kg body weight (maximum 90 mg)1 • 10% of the 0.9 mg/kg dose is given as an initial intravenous bolus • The remaining 90% are infused intravenously over 60 minutes
- 21. Treatment of AIS:Administration of Alteplase Infuse 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the dose given as a bolus over 1 min. Admit the patient to ICU or stroke unit for monitoring. If the patient develops severe headache, acute hypertension, nausea, or vomiting or has a worsening neurological examination, discontinue the infusion and obtain emergency head CT scan. Measure BP and perform neurological assessments every 15 min during and after IV alteplase infusion for 2 h, then every 30 min for 6 h, then hourly until 24 h after IV alteplase treatment. Increase the frequency of BP measurements if SBP is >180 mm Hg or if DBP is >105 mm Hg; administer antihypertensive medications to maintain BP at or below these levels