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
TYPES OF STROKE
TYPES OF STROKE
SUBARACHNOID HEMORRHAGE
RISK FACTOR
STATISTICS
Every 40 seconds
The third leading cause of death & cause of
long-term disability
ISCHEMIC PENUMBRA
ANAMNESIS
delirium, decrease of consciousness
Suddenly
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
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 SAH
Consult to
correlated
dept
Cardio,
Internal dept,
NC
Head CT scan
Labor
Chest X ray
ECG
LP
Diagnosis
Therapy
Thank you