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Stroke Note

The document describes the key steps in stroke management according to the acronym DETECTION: Detection of symptoms, Dispatch of emergency services, delivery of fast evaluation and transport, Door to appropriate treatment center, rapid Data collection and Decision making, administration of Drugs like fibrinolytics. The goal is timelyDisposition to appropriate unit for recovery.

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Hanry Wijaya
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78 views

Stroke Note

The document describes the key steps in stroke management according to the acronym DETECTION: Detection of symptoms, Dispatch of emergency services, delivery of fast evaluation and transport, Door to appropriate treatment center, rapid Data collection and Decision making, administration of Drugs like fibrinolytics. The goal is timelyDisposition to appropriate unit for recovery.

Uploaded by

Hanry Wijaya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd
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detection (pengenalan tanda dan gejala stroke)

dispatch (segera aktivasi EMS)


delivery (kecepatan EMS dalam identifikasi, manajemen dan mentransport pasien
segera),
door (triage yang tepat di stroke center),
data (kecepatan triage, evaluasi dan manajemen di instalasi gawat darurat),
decision (stroke expertise dan pemilihan terapi yang tepat),
drug (pemberian fibrinolitik atau intra-arterial strategi)
disposition (memindahkan ke stroke unit atau critical care unit).

Item Rule
All Score what you see, not what you think
All Score the first response, not the best response, except item 9 best language
All Do not coach
1a May be assessed casually while taking history
2 Only assess horizontal gaze
5 and 6 Count out loud and use your fingers to show the patient your count

Hasil pemeriksaan laboratorium > LED : 45 mm, Hb: 12,6, Ht: 32,6 %, leukosit:
8.800, trombosit:177.000, MCV: 83, MCH: 28,2, MCHC: 35, Hitung jenis : Basofil:
0,2, Eosinofil: 0,2, Neutrofil: 79, Limfosit: 17, Monosit: 3,6. Urinalis: warna
kuning jernih, sel epitel (+), leukosit 4-5, eritrosit 5-6, silinder (-), kristal
(-), bakteri (-), Bj: 1.010, pH: 7, protein negatif, glukosa negatif, keton
negatif, darah/Hb: 2, bilirubin negatif, urobilinogen 3,2, nitrit negatif,esterase
leukosit (+).

CT MRI
Detection of hemorrhage Detection of hemorrhage with SWI
Angiography, better resolution Angiography, non-contrast
Faster, more available, less restrictive Slower, limited availability, restrictive
environ
Radiation No radiation
Limited in posterior fossa Better detection in posterior fossa
Limited detection of small lesions Better detection of small lesions (DWI)
Less specific in detection of “stroke mimics” Better detection of “stroke
mimics,” especially on contrast-enhanced scans

SWI susceptibility-weighted imaging, DWI diffusion-weighted imaging

Nilai GCS (15-14) : Composmentis


Nilai GCS (13-12) : Apatis
Nilai GCS (11-10) : Delirium
Nilai GCS (9-7) : Somnolen
Nilai GCS (6-5) : Sopor
Nilai GCS (4) : semi-coma
Nilai GCS (3) : Coma

NIHSS dan ETSS dikategorikan dalam 4 level yaitu 0, 1-3, 4-23 dan lebih dari 23.
* 4<NIHSS<23 dalam pemberian rtPA,
* NIHSS<4 || NIHSS>23 tidak dapat diberikan fibrinolitik atau rtPA

Original version
Siriraj stroke score =(0 80 x consciousness) + (0 66 x vomiting)
+ (0.66 x headache) + (0 03 x diastolic blood pressure)
- (0 99 x atheroma) - 3 71

Simplified version
Siriraj stroke score=(2.5 x consciousness) + (2 x vomiting) +
(2 x headache) + (0 1 x diastolic blood pressure) - (3 x atheroma) - 12
Consciousness: alern = 0; drowsy, stupor =1; semicoma, coma =2

Vomiting: no =0; yes =1


Headache within two hours: no = O; yes = 1
Atheroma markers: none = O; one or more =1

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harga orang
harga material (barang hasbis pakai)
harga sewa alat
Hrga dokter spesoal, radigrapfer
Harga pajak (10%)+ profit (10%)

data base tarif orang


Database harga MRI seawa perjam

input dan output persyaratan


4 raw paling sedikit.

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