Non differentiated stroke management brain edema and

Info icon This preview shows pages 46–49. Sign up to view the full content.

7. Non-differentiated stroke management. Brain edema and intracranial hypertension: - Corticosteroids (dexamethasone 20-40 mg/day) - Diuretics(osmodiuretics-mannitol or glycerol +loop diuretic-furosemide - Venotic stimulants ( magnesium sulphate/ euphyllin) Control of blood pressure: - Decrease blood pressure only when exceeds 180 only - Decrease only 30%, not to physiological level - Vasodilators: sodium nitroprusside, platyphyline
Image of page 46

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

If no response- IV beta-blockers(labetolol) If no response- ganglion blockers benzohexonium0,00075 mg(very strong) - If BP is low - Should be increased up to physiological - Prednisolone - Symphatomimetics-epinephrine - Analeptics- camphora, sulphocamphocaine Control of cardiac functions Control of respiratory functions: - Transient respiratory ailure or congestive pneumonia may develop - Oxygen theraphy- results in decr of ICP - Preventive antibiotic theraphy (wide spectrum 3 rd generation cephalosporins to prevent pneumonia (1oC incr temp. = incr of mortality 5%) Control of body temperature: - Keep in physiological levels using aspirin or paracetamol Prevention o embolism: - Due to immobilization embolic condition may develop - Anticoagulants- fraxiparine On pharmacological approach: - Blood-letting- to decrease blood pressure - Cranial hypothermia: apply ice on head to decrease metabolism - Position: head elevated by 20 degrees 8. Differentiated stroke management. Indications for surgical treatment and prevention of strokes Parenchymatous hemorrhage: - Hemostatic drugs: vit.K, epsilon aminocaproic acid, ethamsylate (most effective in 12-24 h) - Fibrinolysis inhibitors: contrical Subarachnoid hemorrhage: - Use hemostatics and fibrinolitics inhibitors within first 24 hours - CCB: nimodipine- affects only cranial vessels, prevents vasospasm and decrease mortality 30 mg every 3 hours during first 21 days ater SAH - Surgical treatment ater stabilization of patient Ischemic stroke: Take into consideration time of admission to hospital and mechanism: Embolic: - Within 3 hours after troke: trombolytic- altapase(IV) - After 3 h- anticoagulants: fraxiparine, later changed into warfarin(orally) - Non embolic: - Aspirin till end of patients life 160 mg/day If contraindicated- clopidogrel 75 mg/day lie-long - Lipid lowering theraphy: statins, cholesterol utilizers(clofibuate)
Image of page 47
- Vasoactive drugs: pentoxyphylline, vinpocetine, vincamine (in acute period) - Metabolic treatment: vit. B group, antioxydants-vit. E, nootropics- piracetam, neurotrophic therapy- cerebralysine, citcoline Rehabilitation: motor: ischemic – start 3-4 days after stroke Hemorrhagic- start 3 weeks after stroke Psychological rehabilitation Speech therapy Prevention: - Lifestyle modifications, physical activity , 30-40 min o rapid walking a day - Diet modifications: Mediterranean diet- vegetables, fruits, olive oil resh cheese, black bread, cereals, 30 g of red wine /day - Quit smoking - Decr. Body mass Pharmacological: - Lipid lowering therapy - Monotherapy of aspirin - Warfarin, clopidogrel - Control of BP: CCB(in stenosis of carotid artery) ACE inhibitors, angiotensin receptors inhibitors Indications for surgical treatment: - Cerebellar hematoma -
Image of page 48

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Image of page 49
This is the end of the preview. Sign up to access the rest of the document.
  • Winter '18
  • Jane doe

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern