Aula curta sobre avc

1. Escala pré-hospitalar de Cincinnati
SAMU

2. Medidas gerais
TAC/ RM de crânio
ECG
Testes sanguíneos
Escala de
Cincinnati

3. Medidas gerais
• Posicionar o paciente adequadamente

4. Medidas gerais
• Hipertensão permissiva/ volemia adequada
pen-
me,
ome
irst
in
not
Al-
sive
ore-
d to
gher
nta-
B P in str oke have usually r ecor ded single values of
B P on admission. S ome population studies have
demonstr ated a J -cur ve phenomenon, wher e extr eme
blood pr essur es (both high and low) ar e associated
with adver se outcome.1 3
A r ecent analysis of the I n-
ter national S tr oke T r ial cohor t confir med this r ela-
tionship, suggesting an “ideal” S B P on admission of
150 mm H g.1 2
One study demonstr ated that lower
B P on admission wer e mor e fr equently seen in pa-
tients who wor sened over the fir st 24 hour s, but did
not measur e B P cour se over the fir st 24 hour s.8
I n a
multicenter tr ial of I V nimodipine in acute str oke, an
adver se effect of nimodipine was attr ibuted to a de-
cr ease in B P over the fir st few days after str oke
Figure. Relationship between blood pressure variables
and stroke outcome. Full box group with poor outcome;
box with grids group with good outcome; DBP dia-
stolic blood pressure; %SBP variation degree of systolic
blood pressure variation (reduction) in the first 24 hours
after admission. Comparisons between the two groups
were significant with p 0.05.
NS
NS
.001
NS
.048
.002
NS
NS
NS
NS
NS
NS
NS
NS
hel
October (2 of 2) 2003 NE U ROL OGY 61 1049
Baixar PA se:
PS >200mmHg
PD >120mmHg

5. Medidas gerais
TAC/ RM de crânio
ECG
Testes sanguíneos
Escala de
Cincinnati

6. RM ou TC?

7. RM ou TC?

8. Outros exames complementares
• Glicemia e eletrólitos
– Descartar hipoglicemia e distúrbio metabólico
• Coagulograma
– Base para anticoagulação/ trombólise
• HMG e plaquetas
– Afastar coagulopatias
• Enzimas cardíacas
– Identificar IAM/ risco de cardioembolismo
• Perfil lipídico
– Identificar fator de risco
• ECG
– Arritimias/ risco de cardioembolismo
• LCR

9. Medidas gerais
TAC/ RM de crânio
ECG
Testes sanguíneos
Terapia
apropriada
Escala de
Cincinnati
ABCD2 ≥4

10. Medidas gerais
TAC/ RM de crânio
ECG
Testes sanguíneos
Terapia
apropriada
Escala de
Cincinnati
ABCD2 ≥4