Acute treatment of stroke with medications | NCLEX-RN
Once you start recognizing that someone may be having a stroke maybe he has some of the symptoms we know as stroke symptoms like maybe one side of the person’s face start to fall or maybe suddenly some vision loss or a numbness or weakness on one side of the body so you want to make sure that this person get to the hospital as soon as possible because remember that more than any organ in the body Our brain loves oxygen.
(Seriously guys I love) Brain tissue doesn’t live without it even for a few minutes then in a stroke when the blood stops flowing for a part of the brain and thus deprives the brain of the oxygen it carries, the brain tissue that is losing oxygen Starts to die.
so it’s super important that whoever you suspect of having a stroke, be taken to the hospital ASAP to saves as much brain as possible.
So now that we are in a hospital, what happens there? what will happen? Some things will happen.
I mean, the plan is to diagnose stroke, right, with some tests and some images and then treat stroke with some medications.
Let’s have a look.
We know that part of the diagnosis includes a physical examination.
take a look at any physical signal that the person is having a stroke.
Really important, also include images such as CT (computed tomography) and MRI (magnetic resonance imaging).
This includes lab tests, blood tests to look for an underlying cause of stroke or to rule out other diagnoses like hypoglycemia, which may look like a stroke.
The type of training the person receives It really depends on the type of stroke they had.
Let me show you what I mean here.
You could have had an Ischemic Stroke, for example, where a clot blocks some of the blood vessels in the brain and thus causing a stroke.
Or you may have had a hemorrhagic stroke, for example, where a weakened blood vessel in the brain begins to leak, maybe because of a ruptured aneurysm or some trauma to the head, like a crush or something unpleasant.
but how can the type of stroke do you have, influence the treatment? Because for ischemic stroke, that you can usually identify in images, actually let me clarify that.
You won’t be able to see any brain changes on CT soon after the patient had Ischemic Stroke.
That’s why this CT above here looks pretty normal.
But the key is that it doesn’t look like CT of a hemorrhagic stroke, I’ll show you in a few minutes.
So the patient you suspect is having an ischemic stroke receive medications that you definitely would not give the one with hemorrhagic stroke Let me show you what I mean here.
Let’s bring the blood vein here to demonstrate how these medicines work.
if the patient had an ischemic stroke and came to the hospital as soon as possible, usually two types of medication are given.
One is aspirin, and aspirin actually does nothing with the existing clot can’t destroy it or anything, but what can you do is to prevent the formation of new clots.
It prevents the platelets in your blood from working properly.
why the platelets in your blood are responsible for forming the initial component of the blood clot.
This prevents them from forming.
Really important, you may get a type of medicine called thrombolytic This thrombolytic is what can potentially destroy the clot that is causing the stroke, right? You may have heard of clot clogging and that maybe her type.
“thrombus” means “clot” and “lytic” means “break something”.
This one, in particular, is called Tissue Plasminogen Activator or APT (TPA) That name sounds pretty confusing.
but it’s called a tissue plasminogen activator because of what he does.
it activates a compound called plasminogen that is already naturally found, floating through your blood as part of the body’s natural mechanism to destroy any clot that should not be there.
So APT kinda starts the natural system already in your bloodstream trying to munch the clot causing stroke, right? In fact, when plasminogen is activated by APT, it turns into this component called plasmin and it is she who is actually bursting, the clot exploding, that’s why I wrote plasmin here.
Something very important about this drug, APT benefit is higher shortly after the stroke occurred, and then he kind of stays less and less effective.
Again, I’m just trying to clarify the fact that as soon as the patient arrives at the hospital, better the result and better APT will work.
This is Ischemic Stroke.
This is acute management of an ischemic stroke.
But with hemorrhagic stroke, it’s a different story because when you have leaking vessels, the first thing you want is that clot and stop the bleeding, and then the last thing you want is to activate your plasminogen clot elimination system.
You will not receive APT because if you get APT, then your blood will be much less likely to clot as we saw before.
The blood will only continue to spill blood will continue to spill from this deficiency in the blood vessel here, see? Actually let me bring the CT of a hemorrhagic stroke.
You remember I said I was going to bring one.
You can see all the blood here.
This bright spot is a large portion of blood that’s kind of leaked from the veins in the brain that has a rupture.
You can see that it looks different CT scan on the left of an ischemic stroke.
That’s why a brain scan is so important.
when you are diagnosing a stroke why does this really have big implications on how you treat stroke.
For hemorrhagic stroke, the focus of initial treatment it has to be a little different than with Ischemic Stroke.
For example, with hemorrhagic, it’s very important to find which vein is leaking, so where exactly in the brain is the bleeding.
That can be done by imaging tests like TC or MRI, or angiography we talked about.
because the goal is to stop the bleeding, It is important first to know where it is.
Another thing every time you are bleeding through a vein, losing blood, your heart starts to get a little worried Good old heart always taking care of you he starts pumping some more blood and you think this is going to circulate the blood all over again.
Now her blood pressure has risen.
But there are two main disadvantages to this.
One is that if a small clot has begun to form, to seal the initial blood vessel tear, it’s a new clot maybe not so stable get hit with blood running at high pressure, he may be dislodged and re-bleeding may occur.
The second disadvantage to blood pressure that gets too high is, let’s say the clot didn’t form and still bleeding, still active.
so now the blood will start coming out of the fastest vase And that’s probably the last thing we want.
The patient may receive antihypertensive drugs.
or medicines to lower blood pressure to try to prevent blood pressure from getting too high.
It is also very important with hemorrhagic stroke the treatment team stops or reverses the effects of any medication the patient is taking regularly that can increase the bleeding such as warfarin or aspirin we mentioned earlier.
It is also really important that the pressure builds up in the brain and skull all this blood is controlled.
For starters, a simple way to do this is just to make sure the patient’s head in bed is raised This only works because of the good old gravity.
When the patient’s head is raised, more blood will flow out of the head through the jugular vein, right? This is a way to lower the head pressure a little.
One reason why keeping the pressure on the head at a normal level is really important is that when your brain starts to be pushed or compressed, it kind of disturbs normal electrical activity in the brain and you end up having a seizure.
So doctors might consider giving an anticonvulsant, which is a medicine that prevents seizures from happening.
Another reason is just for some very vital areas in your brain, particularly your brain stem, they can get compressed with all this accumulated pressure and this is very fast and fatal, so we don’t want that.
is there any other surgical way to keep pressure under control but let’s not focus on that now.
But you can definitely get to see the management of hemorrhagic stroke it’s really about managing the patient until interventions like surgeries that can happen.
While with Ischemic Stroke, while you may still need more invasive treatment below the line, at least you can initially give APT to try to sort things out in advance, try to destroy the clot before you need more invasive treatments.
So a quick look at some of the immediate management of ischemic and hemorrhagic stroke.