Emergency: Stroke

• Coronary artery can't rupture.
• Stroke could be a result of hemorrhage --> aspirin could elevate the stroke

brains require lots of oxygen and can't last very long without it.

Occlusion and Hemmorrhagics

thrombotic (in the brain): more common

Embolic(away from the brain): less common

Hem. stroke is more fatal

Hemorrhagic strokes and bc of stress

reversible and complete resolution within 24

• --Similar risk factors as for C.A.D : smoking,
• hypertension, diabetes, elevated cholesterol, family history

• --Hypertension carries the greatest
• relative risk

--Cardiac arrhythmias

--Valvular heart disease

--Carotid artery disease

--History of previous CVA (20% within 1-2 years)

In the dental setting, a sudden rapid increase in blood pressure is the greatest precipitating event.

When to treat?  6 month rule

Confirm that patient took antihypertensive   medications

Check the blood pressure

Stress reduction (sedation can mask neurologic symptoms)

Judicious use of epinephrine

Variable (depending on location of cerebral infarct)

Localized weakness

Numbness

Aphasia 

Severe headache

Vomiting  

Seizure

Loss of consciousness

• Sudden numbness or weakness of
• face, arm or leg - especially on one side of the body.

• Sudden confusion, trouble speaking
• or understanding.

• Sudden trouble seeing in one or
• both eyes.

• Sudden trouble walking, dizziness,
• loss of balance or coordination.

• Sudden severe headache with no
• known cause.

Stop dental procedure

Position patient sitting upright (if conscious) to decrease intracranial pressure.

911—Seconds count.  Stroke victims who receive tPA within three hours are 30% more likely to recover with little or no neurologic deficit. 

Oxygen

Monitor vital signs

Basic Life Support if needed

brain scan --> hemorrhage --> craniotomy to evacuate blood

no blood on brain scan --> receive tPA which dissolve blood clot --> prevent neurologic deficit

Craniotomy to evacuate blood

administer tPA to dissolve clock