Stroke


All pts dx w/ CVA will be required to be on a statin if they have an LDL >= 70 unless contradicted. CMS

St Elizabeth Healthcare STROKE PROGRAM   has an arrangement with the UC STROKE TEAM  to evaluate all patients presenting with stroke symptoms.
The goal is to reach the Stroke Team  MD within 15 of patient arrival or presentation of symptoms for discussion of initial assessment findings and to determine tPA eligibility.
We have recently become aware of some delays in contacting the Stroke team – when the call is initiated through Perfect-Serve
 
HOW TO GET IN TOUCH WITH THE STROKE TEAM            
·       Obtain an outside line from any St. Elizabeth designated telephone.

·       Call  (513)-844-7686

·       You will hear a double beep

·       Enter your 10 digit phone number –  (for the return call)   be sure to include your area code - 859

·       You should receive a call back within 5 min.  If no return call  - contact the University Hospital Operator at (513)584-1000

·      DO NOT USE PERFECT SERVE TO PLACE THIS CALL

 
Blood pressure goals with medication recommendations from the AHA: Stroke BP Goals

Carotid stenosis is an important cause of transient ischemic attacks and stroke. REF NNT = 8 for CEA.

Stroke is the third leading cause of death in the United States, and hypertension is the most consistently powerful predictor of stroke. REF

Intervention BP in stroke ? REF

Hypoxia leads to anaerobic metabolism and depletion of energy stores, increasing brain injury. REF

Ischemic stroke is the 3rd leading cause of death in the US and a common reason for hospitalization.

Aspirin - Check this ref, it's huge and a board question !
USPSTF recommends ASA for males 45–79 years of age when the potential benefit of a reduction in myocardial infarction outweighs the potential harm of an increase in gastrointestinal hemorrhage, and for females 55–79 years of age when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage (SOR A, USPSTF A Recomendation).

The USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years of age or older (USPSTF I Recommendation). It recommends against the use of aspirin for stroke prevention in women younger than 55, and for myocardial infarction prevention in men younger than 45 (USPSTF D Recommendation).

For secondary prevention of future strokes, antiplatelet therapy with aspirin should be initiated within 24 hours of ischemic stroke in all patients without contraindications, and one of several antiplatelet regimens should be continued long-term.

Cerebral edema is the leading cause of death.

What clinical finding is most suggestive of TIA ? Speech disturbance. (REF)
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