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    SNH Tambahan

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    Mega
    The document discusses blood pressure goals and management for patients experiencing ischemic stroke or intracerebral hemorrhage who are candidates for thrombolysis or other acute treatments. It recommends a blood pressure target of less than 185/110 mm Hg for thrombolysis and discusses IV agents that can be used to control blood pressure. It also provides blood pressure guidance for patients who are not candidates for thrombolysis.

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    SNH Tambahan

    Uploaded by

    Mega
    14 views13 pages
    The document discusses blood pressure goals and management for patients experiencing ischemic stroke or intracerebral hemorrhage who are candidates for thrombolysis or other acute treatments. It recommends a blood pressure target of less than 185/110 mm Hg for thrombolysis and discusses IV agents that can be used to control blood pressure. It also provides blood pressure guidance for patients who are not candidates for thrombolysis.

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    The document discusses blood pressure goals and management for patients experiencing ischemic stroke or intracerebral hemorrhage who are candidates for thrombolysis or other acute treatments. It recommends a blood pressure target of less than 185/110 mm Hg for thrombolysis and discusses IV agents that can be used to control blood pressure. It also provides blood pressure guidance for patients who are not candidates for thrombolysis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    14 views13 pages

    SNH Tambahan

    Uploaded by

    Mega
    The document discusses blood pressure goals and management for patients experiencing ischemic stroke or intracerebral hemorrhage who are candidates for thrombolysis or other acute treatments. It recommends a blood pressure target of less than 185/110 mm Hg for thrombolysis and discusses IV agents that can be used to control blood pressure. It also provides blood pressure guidance for patients who are not candidates for thrombolysis.

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    © All Rights Reserved
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    Blood pressure, ischemic stroke, and

    thrombolysis
    • BP goal of <185/110 mm Hg
    • In cases where such a target is not achieved, tPA may even be
    withheld, given the association of elevated BP and risk of sICH
    leading to poor clinical outcomes.
    • A proficient attempt must be made to reduce BP to the
    thrombolytic range, even if it involves using multiple BP agents or
    continuous infusions.
    • Keeping in mind the importance of not making the patient
    relatively hypotensive, the safety of aggressively lowering BP to
    <185/110 mm Hg
    • As discussed, the need for rapid BP control in both
    AIS and ICH often requires IV agents.
    • Some of the commonly used IV medications are
    nicardipine, labetalol, sodium nitroprusside,
    nitroglycerine, enalaprilat, and hydralazine.
    BP and ischemic stroke when
    thrombolysis is not an option
    • As a result, it is best to observe current guidelines, which
    recommend a 15% reduction within the first 24 hours of
    ischemic stroke only in cases where BP exceeds 220/120 mm Hg.
    • Patients with acute ischaemic stroke and a BP lower than
    180/105 mmHg in the first 72 hours after stroke do not seem to
    benefit from the introduction or reintroduction of BP-lowering
    medication. For stable patients who remain hypertensive
    (≥140/90 mmHg) more than three days after an acute ischaemic
    stroke, initiation or reintroduction of BP-lowering medication
    should be considered. Restarting BP control is reasonable after
    the first 24 hours for hypertensive patients who are stable.
    • For ICH patients presenting with SBP between 150
    and 220 mmHg and without contraindication to
    acute BP treatment, acute lowering of SBP to 140
    mmHg is safe and can be effective for improving
    functional outcome.
    • For ICH patients presenting with SBP >220 mmHg, it
    may be reasonable to consider aggressive reduction
    of BP with a continuous intravenous infusion and
    frequent BP monitoring.
    • Patients with cerebellar hemorrhage who are deteriorating neurologically or who have
    brainstem compression and/or hydrocephalus from ventricular obstruction should
    undergo surgical removal of the hemorrhage as soon as possible. Initial treatment of
    these patients with ventricular drainage rather than surgical evacuation is not
    recommended (Class III; Level of Evidence C). (Unchanged from the previous guideline)
    • 2. For most patients with supratentorial ICH, the usefulness of surgery is not well
    established. Specific exceptions and potential subgroup considerations are outlined
    below in recommendations 3 through 6.
    • 3. A policy of early hematoma evacuation is not clearly beneficial compared with
    hematoma evacuation when patients deteriorate
    • 4. Supratentorial hematoma evacuation in deteriorating patients might be considered as
    a life-saving measure
    • 5. DC with or without hematoma evacuation might reduce mortality for patients with
    supratentorial ICH who are in a coma, have large hematomas with significant midline
    shift, or have elevated ICP refractory to medical management
    • 6. The effectiveness of minimally invasive clot evacuation with stereotactic or endoscopic
    aspiration with or without thrombolytic usage is uncertain
    • https://www.slideshare.net/HelaoSilas/hemorrhagi
    c-stroke-66379385

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