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Case presentation on Cerebrovascular accident (Stroke)
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It's comprises of a complete case of cerebrovascular accident (stroke) in SOAP format.
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- 1. CASE PRESENTATION ON HAMMAD KC IV TH PHARM . D CEREBROVASCULAR ACCIDENT 1
- 3. PATIENT DETAILS Name : XYZ IPID : IPID0062194 Age/Sex : 76/ Male Admission Date : 18.06.19 Department : Neurology (GW 5th floor) Weight : 70 Kg Discharge Date : 24.06.19 3
- 4. SUBJECTIVE EVIDENCES CHIEF COMPLAINTS ON ADMISSION c/o forgetting incidence , left hand weakness , deviation of angle of mouth since 1 day c/o slurred speech since 2days H/O fall from the bed , Incontinence of urine PAST MEDICAL HISTORY k/c/o HTN since 20 yrs k/c/o CVA × 5 yrs back 4
- 5. PAST MEDICATION HISTORY T.AMLONG 10 mg (amlodipine) T.LOSAR 25 mg (Losartan) T.DEPLATT 75 mg (clopidogrel) ALLERGY No allergy known 5
- 6. SOCIAL HISTORY Diet : Mixed Sleep : Irregular Exercise : nil FAMILY HISTORY father : k/c/o HTN, DM2, Angina Mother : k/c/o HTN , DM 2 6
- 7. PHYSICAL EXAMINATION 76 years old male patient was admitted in general ward (5th floor) was semi-conscious and disoriented to time , place and surrounding. SYSTEMIC EXAMINATIONS : CVS : S1 S2 heard R S : B/L Air entry (+) Per Abdomen : Soft CNS : Disoriented , semiconscious , Drowsy Local examination: Right UL/LL: 5/5 left UL/LL: 3/5 7
- 8. VITAL SIGNS B.P : 160/100 mmHg R.R : 20 cpm P.R : 128 bpm Temperature : Afebrile 8 OBJECTIVE EVIDENCES
- 9. LABORATORYDATA 9 PARAMETER VALUE NORMAL VALUE Hb (g/dL) 13.2 13 – 18 g/dl pH 7.38 7.35 - 7.45 TLC 8500 4000 – 10000 cells/cu.mm Platelet 3.6 1.5 – 4.5 lakhs/cu.mm Total Cholesterol 225 Less than 200 mg/dl LDL 147 Less than 100 mg/dl PT 10.5 11 - 15.8 sec INR 0.6 0.8 – 1.2 GRBS 145 79 – 160 mg/dl
- 10. RADIOGRAPHIC DATA X-RAY : lung field are clear , cardiac size is normal , osteoporosis seen in chest bone MRI SCAN : Mild to moderate acute infract in right superior cerebral peduncle , infract in bilateral middle and inferior cerebral peduncle. ANGIOGRAM : bilateral internal carotid artery show intimal thickening. 10
- 11. PATIENT ASSESMENT SUBJECTIVE EVIDENCE C/O forgetting incidence ,Deviation of angle of mouth, H/O fall from bed , H/O left hand weakness , H/O incontinent of urine , c/o slurred speech. Past medical and medication history evidences Systemic examination evidences like CNS Local examination of arms 11 OBJECTIVE EVIDENCE LAB investigation like BP, PR, Total cholesterol , PT, INR, LDL MRI SCAN : mild to moderate acute infract in cerebral peduncle ANGIOGRAM ; Bilateral internal carotid artery internal thickening
- 12. PATIENT ASSESMENT Based on the subjective and objective evidence the patient was diagnosed with CEREBROVASCULAR ACCIDENT (CVA) 12
- 13. GOALS OF TREATMENT To minimize the signs and symptoms of stroke reduce ongoing neurologic injury and decrease mortality and long-term disability, prevent complications secondary to immobility and neurologic dysfunction prevent stroke recurrence. To maintain normal vitals To improve quality of life & avoid fresh complaints. To provide non-expensive & effective treatment. 13
- 14. PLANNING DRUG CHART 14 BRAND NAME GENERIC NAME DOSE FREQUENCY INJ.HEPARIN Heparin 5000U 1-1-1 Inj.STROCIT Citicoline 250mg/ml 1-0-1 T.COLIHENZ Citicoline 500mg 1-0-1 INJ.LEVIPIL levetiracetam 500mg 1-0-1 T.ATORVA Atorvastatin 20mg 0-0-1 T.BETALOC Metoprolol 25mg 1/2-0-1/2 T.PAN Pantoprazole 40mg IV 1-0-1 T.ECOSPRIN Aspirin 150mg 0-1-0 DAY Day 1 – 3 Day 1 – 3 Day 4 – 5 Day 1 - 4 Day 1 - 5 Day 1 - 3 Day 3 - 5 Day 3 - 4
- 15. DRUG CHART 15 BRAND NAME GENERIC NAME DOSE FREQUENCY Syp.POTKLOR Potassium chloride 15ml 1-1-1 Syp.CREMAFIN Mg(OH)² , Liquid paraffin 30ml 1-0-1 DAY Day 2 - 5 Day 3 - 5
- 16. PROGRESS CHART 16 DAY 1 Pt. was admitted with given complaints and kept under observation in ICU for 48 hrs and patient have c/o hematuria DAY 2 All vitals checked and reported. No fresh complaints. DAY 3 Patient became completely conscious, vitals checked and reported Complaints of constipation DAY 4 Comprehension of speech Mild dysarthria No c/o blood in urine , headache , vomiting Requested for discharge
- 17. GOALS ACHIEVED Disease progression is stopped and symptoms are improved All vitals came to normal Quality of life improved. 17
- 18. PLANNING SUGGESTION TO PHYSICIAN Drug interactions 1. Heparin + Aspirin : result in potentiated risk of bleeding complication close monitoring with dose adjustment according to the INR reading. Relevant investigation like ECG and CT scan reports are not included. Frequency of the past medications is not provided. 18
- 19. PATIENT COUNSELLING Disease related : Cerebrovascular accident also called stroke which is a condition in which the damage to the brain from interruption of the blood supply. Pharmacotherapy related : Citicoline is used for stroke , it’s a nerve protecting medicine , nourish and protect nerve cell Heparin and aspirin is used to prevent blood clots Atorvastatin is used to control the blood cholesterol (HMG CoA reductase 19
- 20. Life style and diet modifications : advised to take low fat , slow salted food Avoid whole milk , try skim or non fat Reduce fatty meat , egg yolk , liver Increase intake of nuts , seeds , dry beans Increase and promote intake of vegetables and fruits like banana , carrot , beetroot, apple etc… Learn new ways of cooking like baking or broiling instead of frying 20
- 21. SUMMERY Pt. got admitted on emergency basis with chief complaints relevant investigation is done like chest X Ray , ECG , MRI scan , MRI Angiogram to confirm stroke. Hence treatment is started on basis of subjective and objective evidence with drugs like inj.LEVIPIL , INJ.STROCIT , T.ATORVA , T.DEPLATT etc.. Later patient improved symptomatically and discharged on following advise T.DEPLATT 75mg 0-0-1 3 days T.ATORVA 20mg 0-0-1 6 days T.PAN 40mg 1-0-1 6 days Review the doctor after 1 week in OPD 21
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Ischemic Stroke Clinical Case
Ischemic stroke clinical case presentation, free google slides theme and powerpoint template.
An ischemic stroke is what happens when one of the vessels that supply the brain gets obstructed, and it can cause serious damage to the brain. In order to identify when something like this might be happening to us, we must go FAST. This doesn’t mean that we should rush, FAST is the acronym of Face dropping, Arm weakness, Speech difficulty and Time to call 911. Those are the things you need to identify as soon as possible to lessen the effects of a stroke. Are you aware of techniques like this one? Or maybe you have developed a new treatment for people affected? With this template that combines red and white you can explain it all in detail! The information will be crystal clear thanks to the different resources we have included to help you give medical data: graphs, maps, charts… Everything is editable, so you can adapt the presentation to your needs. Download it now and start preparing a presentation that will save lifes!
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Stroke Case Studies.
Published by Esmond McCoy Modified over 7 years ago
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Presentation on theme: "Stroke Case Studies."— Presentation transcript:
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Stroke Case Studies
Stroke case studies case study 1 72 yo female collapses at home while eating dinner with her daughter. ems brings the patient to your er and you note the following ... – powerpoint ppt presentation.
- 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note the following garbled speech, right sided hemiplegia, able to briskly follow commands with left side, and able to write answers to questions. Vitals BP 177/90, P 88 bpm and irregular, RR 18, O2 95 on room air
- Administer IV tPa
- Give 10 mg IV Labetalol
- Obtain STAT head CT
- Obtain STAT brain MRI
- Right Middle Cerebral Artery (MCA)
- Left Middle Cerebral Artery (MCA)
- Right Anterior Cerebral Artery (ACA)
- Left Anterior Cerebral Artery (ACA)
- Adams Aphasia
- Wernickes (receptive) aphasia
- Brocas (expressive) Aphasia
- Global Aphasia
- Mrs. Liken is a 48 yo female who presents to the ED with the worst headache of her life. She states the pain is the worst in the back of her head and her neck. Past medical hx HTN (noncompliant) and tobacco use. Vitals 174/88, 103, 99 on room air, RR 22
- Intracerebral Hemorrhage
- Subdural Hematoma
- Epidural Hematoma
- Subarachnoid Hemorrhage
- Make the patient NPO for the procedure
- Assure adequate hydration given the large contrast load
- Obtain echocardiogram to assess for myocardial stunning
- Strict blood pressure control to prevent re-rupture of the aneurysm
- EMS brings a 59 yo homeless male to your Emergency Department. No known past medical history is known. EMS was called when the patient was found in a park on the ground shaking his left arm and leg. Positive loss of consciousness was briefly noted.
- The patient regains consciousness in the ambulance but is substantially weaker on his left side. He states this is new. EMS initiates CODE STROKE per protocol. CT of head is negative for hemorrhage and the patient is unable to receive an MRI 2/2 bullet fragments.
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Stroke:Case Study Section 2
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly , Kim Jackson , Rucha Gadgil and Simisola Ajeyalemi
- 1 Introduction
- 2 History of Presenting Condition
- 3 Past Medical History
- 4 Medication History
- 5 Social History
- 6 Pre-Hospital Assessment
- 7 Acute Hospital Assessment
- 8 Investigations
- 9 Medical Management
- 10 Physiotherapy Objective
- 11 Physiotherapy Management
Introduction [ edit | edit source ]
This case study forms part of the Stroke Course
History of Presenting Condition [ edit | edit source ]
Michael is a 61 year old Senior Partner in a Law Firm. While eating breakfast Michael experienced sudden onset slurring of speech, had facial droop on his left hand side with weakness in left side upper and lower limbs. Michael's wife Mary spotted these sudden onset of symptoms and immediately called for an ambulance, which arrived within 15 mins.
Past Medical History [ edit | edit source ]
Asthma - Dx Aged 8
Hypertension Grade 1 - Dx 5 years ago
Prediabetes - Dx 3 years ago
Medication History [ edit | edit source ]
Seretide Accuhaler
Ventolin (As Required - Not Required for over 1 Year)
Social History [ edit | edit source ]
61 Year Old Senior Partner at a Law Firm, recently reduced working hours 20 - 30 hours per week, previously worked 50 - 60 Hours
Planning on retirement in 1 - 2 years
Lives in a Bungalow with his wife Mary, who is a recently Retired Teacher.
2 Adult Children, both married with their own children - 1 lives close by, the other lives overseas.
Lifestyle Changes implmented over past 2 - 3 Years foloowing Dx Prediabetes.
Outside work he enjoys golf, usually playing at least 2-3 per week. Also enjoys playing Bridge with Friends.
Took up walking 3 Years ago following Dx Prediabetes. Walks 5 - 6 days per week for between 30 - 45 mins
Ex-Smoker - Hx Smoking 30 Years x 10 - 15/day - Quit 3 Years ago following Dx Prediabetes
Social Beer Drinker 10 - 15 Standard Drinks per week with 3 - 4 per session, although sometimes after Golf may be more.
Pre-Hospital Assessment [ edit | edit source ]
- BP 140/90 mmHg
Physical Exam:
- Left Facial Droop
- Left Motor Weakness: Upper Limb 0/5, Lower Limb 2/5
- Slurred Speech
Pre Hospital Assessment Scale:
Los Angeles Prehospital Stroke Screen (LAPSS) & Los Angeles Motor Scale (LAMS)
Acute Hospital Assessment [ edit | edit source ]
- BP 145/90 mmHg
- Left Motor Weakness Upper Limb 0/5, Lower Limb 2/5
- Decreased Tone
- Altered Sensation
- Mild Left Sided Neglect
Acute Assessment Scale:
NIH Stroke Scale : 19
Investigations [ edit | edit source ]
- Hyperdensity in the M1 Segment of the Right Middle Cerebral Artery, with no other signs suggestive of an Ischemic Stroke noted. Provisional diagnosis of Acute Ischemic Stroke secondary to occlusion of the M1 was made Patient was treated with intravenous Tissue Plasminogen Activator (tPA) at 1 h 54 min after symptom onset
- Multimodal MRI Scan completed at 3 h 09 min after symptom onset demonstrated Ischemic Changes confined predominantly to the Right Middle Cerebral Artery
- Perfusion-weighted MRI showed larger perfusion abnormality, indicating presence of a substantial volume of potentially salvageable penumbral tissue.
- Time-of-flight magnetic resonance angiography showed a loss of signal in the Right Internal Carotid Artery and Middle Cerebral Artery.
Cerebral Angiography
- Cerebral angiogram performed post MRI demonstrated Occlusive Thrombus extending from the Right Internal Carotid Artery Origin through the Right Middle Cerebral Artery Trunk.
- Recanalization was attempted by Endovascular Thrombectomy performed 4 h 19 min after symptom onset
Medical Management [ edit | edit source ]
Thrombolysis & Endovascular Mechanical Thrombectomy:
- Discussed with Family & Patient
- tPA Prescribed and Initiated within 1hr 54mins After Onset Symptoms
- Endovascualr Thrombectomy Initiated at 3hr
Stroke Unit:
- Admitted to Acute Stroke Unit
- 24 Hour Monitoring
- MDT Referral Received within 24 Hours - OT, SLT & PT
Physiotherapy Objective [ edit | edit source ]
Physiotherapy management [ edit | edit source ].
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stroke is blocking of blood flow to brain due to formation of thrombus in the vessels supply to brain.
It's comprises of a complete case of cerebrovascular accident (stroke) in SOAP format.
Acute ischemic stroke. Heparin low-molecular-weight heparins (LMWH). Medline (OVID): → “Map Term to Subject Heading“. Stroke → *Cerebrovascular Accident/.
Prepare a presentation that will save lifes with this template for an Ischemic Stroke clinical case! Downlaod and edit it in Google Slides and PowerPoint.
Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note the following: garbled
Stroke Case Studies Case Study 1 72 yo female collapses at home while eating dinner with her daughter. EMS brings the patient to your ER and you note the
... Blood pressure >140/90, Clinical presentation, Duration of symptoms, and the presence of Diabetes) to stratify risk of subsequent stroke.
He received Alteplase intravenous tPA and was transferred to a comprehensive stroke center where angiography confirmed mid-basilar occlusion (Figure 3
Stroke: Ischemic. SCENS. Learning Objectives. Complete a focused assessment on the patient presenting with signs and symptoms of a stroke; Initiate facility
Confusion · Left Facial Droop · Slurred Speech · Left Motor Weakness Upper Limb 0/5, Lower Limb 2/5 · Decreased Tone · Altered Sensation · Mild Left Sided Neglect.