Protocols - Hemorio

- Lumbar puncture (suspicion of HSA with normal CT)
- Cervical column x-ray (In the suspicion of cervical or cranial trauma, height fall, pain or cervical rigidity).
- Young subjects: rheumatologic screening and thyroidal function
- On special cases: C and S protein level, antithrombins III, Leiden factors VII, VIII and V, Tissue
plasminogen activator (TPA) and plasminogen activator inhibitor PAI, homocistein, prothrombin
mutationanticardiolipine (IgG and IgM) and lupus anticoagulant.
CLASSIFICATION OF STROKE:
ORIGIN:
- ISCHEMIC
- HEMORRAGIC
EPISODE DURATION:
- TIA –Transitory ischemic attack – neurologic deficit up to 24 h, without sequels.
- “in crescendo” TIA – two or more TIA episodes in 24 hours (it is one of the most important
neurological emergency).
- RIND – Reversible Ischemic Neurological Deficit – lasts more than 24 h, with delayed deficit
reversibility. More detailed exams show minimal sequels
- “ONGOING STROKE”: signals and symptoms aggravated
- COMPLETE CEREBRAL INFARCTION
STROKE – THERAPEUTIC APPROACH:
1 – Maintain free and functioning the respiratory airways
2 –ECG and oximetry monitoring: evaluate O 2 suplementation
3 – Maintain elevated thorax and head at 30 o
4 – Research cranial or cervical trauma and cardiovascular changes
5 –Neurological Exam: Conscience Level, convulsive episodes, Glasgow Coma Score, pupils (symmetry,
reactivity) and four limbs movement.
6 - Hydration
6 - If PA is above 220 / 110 mmHg, it should not be acutely reduced
7 – Looking for reversible causes (bad positioning, pain, hypoxia) If there is arterial hypotension: volemic
reposition, vasoactive amines.
8 – Cardiac monitoring
SUMMARY DESCRIPTION OF NEUROLOGIC EXAM
Dimidiate motor deficit Hemiparesis or hemiplegia or unilateral central facial paresia
Sensitivity Deficit Reduction or loss of painful or tactile sensitivity
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