Gaba Analog used with opiod may cause respiratory suppression Pregabalin (Lyrica) Caution when used with opioid and benzo Excreted from urine 90% unchanged Pregnancy: category C Pregabalin Capsule: 25, 50, 75, 100, 150, 200, 225, 300 mg (generic about $30 for 60 cap) Pregabalin solution: 20 mg/ml Lyrica CR:...

Large artery atherosclerosis Cardiac embolism Small Vessel disease Other determined etiology Dissection Hypercoagulability Other Cryptogenic Stroke Multiple potential etiologies Undetermined etiology Unspecified...

Mechanical thrombectomy mRS = Modified Rakin Scale. ASPECTS = Alberta Stroke Program Early Computed Tomography Score Do not delay TPA if indicated. Occlusion of internal carotid artery or M1 segment Age 18 or over Acute stroke onset < 6 hours Prestroke mRS score <2 (meaning no significant disability despite symptoms,...

First 24 hr post TPA Get CTA of head and neck if not contraindicated, creatine normal. No antiplatelet (including aspirin), no anticoagulant for 24 hours Bed rest Keep BP <185/105 Acetaminophen if temperature over 38 degree C Treat hyperglycemia to achieve a range of 140-180 Avoid arterial puncture, Foley,...

Risks For treatment within 3 hours, good outcome with tpa 33% vs 23% for control group. (10% better chance of good outcome) Risk of symptomatic intracerebral hemorrhage: 6.8% in tpa group, 1.3% of control group. (1 in 14 will have a bleed. ) Risk of Fatal intracerebral hemorrhage within...

Goal: Door to needle under 45 minutes (Time from arrival to TPA given) Tests: Absolutely needed CT head wo contrast to rule out bleed glucose > 50 Get the following but do not delay tpa O2 sat- BMP, CBC, INR, PTT troponin, ECG Consider TPA if: Significant neuro deficits: such...

History: sudden onset, Neuro deficit speech problem” repeat sentence, naming Facial droop weakness, check arm drift, rapid alternating movement, finger to nose Visual field, eye movement problem Onset: Get Time of Last known normal (LKN) from patient or family CT head stat: if it shows intracranial bleed Check glucose...

Treatment: IVIG 0.4 gram/kg/day x 5 days less likely to discontinue rx compared with plasma exchange unproven: more severe disease may benefit from long duration of ivig unproven: repeat dose may help, controversial side effect: aseptic meningitis, rash, acute kidney disease Plasma exchange 4 to 6 exchange over 8-10...

Coma patients 8% has NCSE in ICU 30% has NCSE in ED 30% after CPR Up to 78% in autoimmune encephalitis 3-13% in Subarachnoid hemorrhage Reference Sutter, et al Nature Reviews 2016...

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