Pre PACES Podcast #65 BAMR: Calling Stroke (part 1)
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Jul 16, 2023 Dr. Paul Sellors, a Consultant in stroke medicine at North Bristol Hospital NHS Trust, shares his expertise in managing stroke cases. He delves into the nuances of thrombolysis, explaining when it is most effective, and discusses the critical time window for treatment. The conversation also covers assessing stroke mimics, understanding key assessment scores like NIHSS, and the risks involved with thrombolysis. Additionally, Paul offers practical tips on managing blood pressure and glucose levels in acute stroke patients.
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Penumbra Versus Core Explained
- Penumbra is electrically failed but salvageable brain tissue that causes symptoms but can recover if reperfused.
- Core is dead brain that will not benefit from reperfusion and may bleed if reperfused.
Confirm Exact 'Last Seen Well' Time
- Do determine an exact 'last seen well' time because thrombolysis without advanced imaging is only safe up to 4.5 hours.
- Do get collateral from paramedics or family quickly if the patient cannot report onset themselves.
Use NIHSS But Consider Context
- Do use NIHSS during assessment and strongly consider thrombolysis for NIHSS ≥4 within the time window.
- Do still consider thrombolysis for severe deficits (e.g., aphasia, hemianopia) even if NIHSS <4.