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EMERGENCY MANAGEMENT OF CEREBROVASCULAR

ACCIDENT (CVA / STROKE)


Abdurahman Wahid, Ns., M.Kep
STROKE AND RISK FACTORS
hipertensi

kolesterol

merokok

obesitas

A-Fib

hipertensi

Usia Gender riwayat stroke Ras Riwayat keluarga


TERMINOLOGI
Stroke Iskemik

Stroke Haemorrhage

Transient Ischemic Attack (TIA)

Haemorrhage
13%

Ischemic
87%
persentase jenis stroke
AHA GUIDELINES (2010)
CHAIN OF SURVIVAL
DETECTION DOOR

DISPATCH DATA

DELIVERY DECISION

DRUG
Prehospital

Hospital
DISPOSITION
DETECTION

Kunci penting dalam aktivasi


sistem

Problem ?

Solusi: FAST Education


DISPATCH

aktivasi EMS

Tugas EMS:

Rapid transport

Perform live saving intervention

Sending patient to the right


hospital at the right time and
right way
CRITICAL EMS APPROACH
Support ABCs and provide supplemental O2 to hypoxemic (eg,
Support ABCs oxygen saturation < 94 %) stroke patients or those with unknown
oxygen saturation

Perform Stroke
Perform a rapid out - of - hospital stroke assesment (CPSS)
Assesment

Determine when the patients was last known to be normal. This


represents time zero. If the patients wakes from sleep with
Establish Time
symptoms of stroke, time zero is the last time the patients was
seen normal

Transport (with support cardiopulmonary function) rapidly to


Triage to Stroke center stroke centre. Bring witness or family member to confirm time of
onset

Alert hospital Provide prearrival notification

Check Glucose Exclude hypo / hyperglicemia


DELIVERY

Selalu gunakan Ambulan sebagai kendaraan rujukan

Selalu sertakan keluarga terdekat

Rujuk ke RS dengan fasilitas CT Scan dan spesialis saraf / bedah saraf

Selalu jalin komunikasi dengan RS rujukan


HOSPITAL TIMELY PLANNING
Immediate General Assesment 10 minutes

Immediate Neurologic Assesment 25 minutes

Acquisition of CT of the Head 25 minutes

Interpretation of CT Scan 45 minutes

Administration of Fibrinolytic therapy, timed from ED arrival 60 minutes

Administration of Fibrinolytic therapy, timed from onset of 3 hours or 4,5


symptoms hours

Admission to a monitored bed 3 hours


DOOR

Emergency Department Triage

Too often hours may elapse before appropriate neurological


consultation and diagnostic studies are performed
DATA

Immediate General Assessment and Stabilization

Check Glucose

Neurological Stroke assessment

Emergency Diagnostic Studies : CT Scan

12 Lead ECG
IMMEDIATE GENERAL
ASSESSMENT AND STABILIZATION

Assess ABC and vital signs

Provide Oxygen if Hypoxemic

IV Access and laboratory Assessment

Treat if Hypoglycemia
NEUROLOGIC ASSESSMENT

review history

Establish time of Onset

Neurologis Examination: NIHSS


EMERGENT CT SCAN
DECISION
Spesific Stroke Therapies

Ischemic Vs haemorrhage

General care includes:

Prevention of aspiration

Management of Hypertension

Management of Hyper / Hypoglycemia

Management of Seizures

Management of ICP
DRUG : R-TPA

N Engl J Med 1995;333:1581-7


MANAGEMENT OF
HAEMORRHAGE STROKE
Optimal Management:

prevention of continued bleeding

appropriate management of ICP

Timely neurosurgical decompression when warranted

Large intracerebral or cerebellar hematomas often require surgical


intervention

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