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CEREBROVASCULAR

DISEASE : AN EMERGENCY
dr. Nilamsari Sp.S M.Kes
Neurology Departement
Medical Faculty of Sriwijaya
University/
M. Hoesin General Hospital

WHAT IS STROKE

DEFINITION OF STROKE
Neurologic

deficit, focal or global


Sudden onset
Lasts for 24 hour or death end
Cerebovascular system disturbance

TYPES OF STROKE

TYPES OF STROKE

SUBARACHNOID HEMORRHAGE

RISK FACTOR

HOW OFTEN DOES


STROKE OCCURS IN COMMUNITY

STATISTICS

Every 40 seconds
The third leading cause of death & cause of
long-term disability

WHY IS STROKE CONSIDERED AS


AN EMERGENCY CASE

TIME IS CRITICAL : 3 HOURS WINDOW


To

save ischemic penumbra


To reduce mass effect

ISCHEMIC PENUMBRA

REDUCING MASS EFFECT

HOW TO ESTABLISH THE DIAGNOSIS

ANAMNESIS
delirium, decrease of consciousness
Suddenly

trouble speaking or understanding


trouble seeing
trouble walking, dizziness, loss of
balance or coordination
one side numbness or weakness
of the face, arm or leg
severe headache

PHYSICAL EXAMINATION

Consciousnes
Vital sign
General status
Neurological examination

DIFFERENTIAL DIAGNOSIS
Sign & Symp

Thromboti
c

Activity at
onset

Neuro deficit

worsening Max at
Max at
onsetimprov onset
e

minimalwors
e

Headache

+/-

+/-

++

Vomitting

+/-

+/-

+/-

Seizure

+/-

+/-

+/-

Decrease of
consciousnes
s

+/-

+/-

+/-

TIA

BP

N/
-

N/
+

+/-

++

Nuchal
rigidity
Bleeding LP

Embolic
+

Hemorrhag
e
+

SAH
+

TIME IS
BRAIN
MANAGEMEN
T

MANAGEMENT
Pre
ER

hospital

PRE HOSPITAL MANAGEMENT

Early detection
Patient transported ambulance
Initial assessment
ABC (Normal Saline, Ringer Asetate)
Transferred to refferal hospital immediately

MANAGEMENT AT ER
Anamnesis
Airway & Breathing
Oropharingeal tube
ETT
Oxygen binasal
Circulation
Intravenous line :Normal saline, ringer asetat
Proper management for BP

BLOOD PRESSURE
CONTROL
BP >
220/140

BP 220/121140

BP 180220/
105-120

BP 220/121140

Hemorrha
ge/organ
demage

Yes

Parenteral
antihypertensio
n

BP
<
180/105

No

observatio
n

Management at ER
Initial physical exam
Control elevated cerebral pressure
Head elevated 30
Manitol 0.25 0.5 mg/BW over > 20 min,
repeated every 4-6 hr
Furosemide 1 mg/BW iv

Management at ER
Seizure Control
Diazepam 5 20 mg slow iv
Phenitoin for prophylactic antiepileptic
Febris control
Acetaminophen 650 mg

Management at ER
Laboratorium
ECG
Chest x ray
CT scan
LP

CT SCAN OF ISCHEMIC STROKE

CT SCAN OF HEMORRHAGE STROKE

CT SCAN OF SAH

MANAGEMENT AT ER : FLOW CHART


Identification & initial
assessment
ABC

Consult to
correlated
dept
Cardio,
Internal dept,
NC

Head CT scan
Labor
Chest X ray
ECG
LP

Diagnosis

Therapy

Thank you

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