Lernkarten
Welche Massnahmen verbessern das outcome von CVI-Patienten massgeblich?
4
- Stroke care in specialised units (Stroke units)
- Platelet inhibitors such as acetylsalicylic acid within 72 hours
- Intravenous thrombolysis within 4.5 hours
- Hemicraniectomy within 48 hours (see reference below)
Welche Patienten sind IPS-pflichtig?
6
- Large, space-occupying hemispheric infarct
- Space-occupying cerebellar infarct
- Basilar artery thrombosis
- Septic embolic infarction secondary to bacterial endocarditis
- Stroke associated with cardiothoracic surgery
- Pre- and post-intervention care of stroke-related angiography.
Akutes Management von CVI-Patienten?
4
- Resuscitate, look for circulation, oxygenation, body temperature and blood glucose.
- Immediately assess the indication for acute revascularisation.
- Determine the possible cause of the stroke. This will facilitate institution of optimal secondary prophylaxis, with the aim of preventing early recurrences.
- Assess the optimal management location – emergency department (ED), stroke unit (SU) or ICU
Warum akutes Strokemanagement wenn doch Hirnareale längst abgestorben sind? (Ischämiezeit von 3min reichen!)
Sekundäre Prävention:
- Erhalten der Penumbra
- Vermeiden von Komplikationen, speziell bei TIA
Welche Patienten machen respiratorische Probleme in der Akutversorgung?
3
Patienten mit
- brainstem infarction
- large hemispheric infarctions
- space occupying lesions
Was passiert wenn Blutdruck nach Ischämie zu niederig ist?
Zu hoch?
Zielblutdruck VOR Lyse?
If the pressure is too high this may exacerbate reperfusion injury to the penumbra and lead to increased oedema, cellular hypoxia or haemorrhagic transformation.
If the pressure is too low, CBF in the penumbra can decrease to a level causing irreversible neuronal damage; additionally, this can cause vessels in intact brain regions to dilate, which can then lead to a potential âsteal-effectâ, further promoting ischaemia in the penumbra.
≤185 mmHg and diastolic blood pressure is ≤110 mmHg
Blutdruckziele bei intrakranieller Hämorrhagie?
mit vorbekannter /nicht vorbekannter Hypertonie?
-upper recommended limit of 160/95 mmHg in patients without known hypertension. If treatment is necessary, target blood pressure 150/90 mmHg
-upper limit of systolic blood pressure of 180 mmHg if known hypertension and, if treatment is necessary, target blood pressure is 160/100 mmHg.
Wann müssen Blutdruckvorgaben angepasst werden?
suspected aortic dissection, hypertensive encephalopathy, subarachnoid or intracerebral bleeding, severe heart failure, acute myocardial infarction or unstable angina.
In these situations, a compromise has to be achieved.
