1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. goals of management
2.1.1.1. stabilize the patient
2.1.1.2. prevent further infarcts
2.1.2. ED
2.1.2.1. ABC
2.1.2.1.1. intubation recommended to prevent aspiration
2.1.2.1.2. shouldn't be done if the patient breathes normally
2.1.2.1.3. oxygen mask
2.1.2.2. for HTN
2.1.2.2.1. should be below 180/110 for thrombolysis
2.1.2.2.2. usually gradullay treated to maintain circulation after 24 hours
2.1.2.3. monitoring
2.1.2.3.1. glucose level
2.1.2.3.2. swallowing and speech
2.1.2.3.3. heart function
2.1.2.3.4. fever
2.1.2.3.5. investigations
2.1.2.4. IV fluid
2.1.2.5. positioning
2.1.2.5.1. keeping him flat to maximize the cerebral circulation
2.1.2.5.2. not longer than 24 hours
2.1.3. short term
2.1.3.1. Thrombolytic therapy
2.1.3.1.1. tPA
2.1.3.1.2. eligiblaty
2.1.3.2. Anti platelets
2.1.3.2.1. Aspirin
2.1.3.3. stroke center
2.1.3.3.1. well-trained stroke team should be available
2.1.3.4. surgery
2.1.3.4.1. stenting
2.1.3.5. Statin
2.1.3.5.1. used if the stroke ischemic
2.1.4. long term
2.1.4.1. medications
2.1.4.1.1. Aspirin
2.1.4.1.2. anticoagulation used if the stroke cause is cardiac
2.1.4.2. rehab
2.1.4.2.1. restore the daily life activities
2.1.4.2.2. walking aid
2.1.4.2.3. speech therapy
2.1.4.2.4. swallowing therapy
2.1.4.3. psychiatrist referral
2.1.4.3.1. addressing the depression
2.1.4.3.2. high chance to get PTSD
2.1.4.4. lifestyle modification
2.1.4.4.1. smoking cessation
2.1.4.4.2. weight control
2.1.4.5. social worker consultation
2.1.4.6. prognosis
2.1.4.6.1. 25% die within 2 years
2.1.4.6.2. mortality higher with hemorragic stroke
2.1.4.6.3. it depends on the location of infarction
2.1.4.6.4. the larger the deficits, the poorer the outcome
2.2. Prevention
2.2.1. primary prevention
2.2.1.1. reduce the risk factors
2.2.1.1.1. metabolic syndrome
2.2.1.1.2. smoking and alcohol cessation
2.2.1.1.3. OSA
2.2.2. secondary prevention
2.2.2.1. community and emergency staff awareness
2.2.2.1.1. OC risk?
2.2.2.2. management and control other diseases
2.2.2.2.1. especially AF
2.2.2.3. screening campaigns
2.2.2.4. assessment of bleeding disorders