Vincentius Darryl

Michael Olivier
Introduction
Subtype of strokes
 AHA/ASA
GUIDELINES
2018
PREHOSPITAL MANAGEMENT OF STROKE
 1.1
Prehospital
System
 1.2
EMS
Assessment
and
Management
 1.3
EMS Systems
 1.4
Hospital
Stroke
Capabilities
 1.5
Hospital
Stroke Teams
 1.6
Telemedicine
EMERGENCY EVALUATION AND TREATMENT
 2.1
Stroke Scales
NIHSS SCORE
NIHSS SCORE
2.2 Brain
Imaging
GENERAL SUPPORTIVE CARE AND EMERGENCY TREATMENT
 3.1 Airway,
Breathing and
Oxygenation
 3.1
Blood Pressure
 3.3
Temperature
 3.4
Blood
Glucose
 3.5
IV
Alteplase
 3.5
IV Alteplase(CMB)
 3.5
IV Alteplase
 3.5
IV Alteplase
Treatment
using
Alteplase
Treatment of
ICH during
Alteplase
 Jika tambah parah  Hereditary &
Maintain airway Epinephrine (0.1%) 0.3 ACEI related
ml SC / nebulizer 0.5 ml angioedema:
• Incatibant 3
ml (30 mg) SC
(+) Ranitidine 50
 abdominal
(x) IV alteplase mg IV /
famotidine 20 (interval 6
& hold ACEIs
jam)
mg IV
• Plasma-
derived C1
(+) IV (+) IV esterase
methylprednisol diphenhydramin inhibitor 20
one 125 mg e 50 mg IU/kg

Treatment of Angioedema
 3.6
Other IV
Thrombolytic
and
Sonothrombolytic
 3.7
Mechanical Thrombectomy
 Apa itu
Mechanical
Thrombectomy
 3.7
Mechanical Thrombectomy
Pre Stroke MRS (Modified Rankin Score)
ASPECTS
SCORE
Mechanical Thrombectomy > 6 jam
 • Menggunakan Rapid
Software Ischema view
Injeksi kontras untuk melihat > 6 detik • Harus ada indikasi buat
perubahan warna inisiasi 6-16 jam
• Volume infark awal < 70 ml
• Volume ischemic / infark >
1.8
• Potensi reversibel pada
penumbra > 15 ml
• Harus oklusi pada ICA dan
MCA proksimal
Clinical Imaging
Requirement
3.8 Other EVT
3.9 Antiplatelet Treatment
 3.9
Antiplatelet
Treatment
(Others)
 3.10
Anticoagulant
 3.11 Volume
expansion/Hemodilution
agents
 3.12
Neuro Protective Agents
In-Hospital Management of AIS
General Supportive Care
4.1 Stroke Units
4.2 Supplemental Oxygenation
4.3 Blood
Pressure
4.3 Blood
Pressure
4.4 Temperature
4.5 Glucose
4.6 Dysphagia
Screening
4.7
Nutrition
4.8
DVT
Prophylaxis
 4.9
Depression
 4.10
Others
4.11
Rehabilitation
 In-Hospital Management of AIS
Treatment of Acute Complications
5.1 Cerebellar and
Cerebral Edema
5.1 Cerebellar and Cerebral Edema
 5.1
Cerebellar
and Cerebral
Edema
 5.2
Seizures