ICU 'uncut' academic discussions #4: How to manage acute ischemic stroke in ICU & ED; Dr Sushant
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- Опубликовано: 1 фев 2023
- #ischemic_stroke
The above video is a part of our - The ICU room "uncut" academic discussions;
How to manage acute ischemic stroke in ICU & emergency department. We thank Dr Sushant, Consultant Neurologist for sparing time ans sharing very important points with us for this session.
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I don't have words to describe my happiness after seeing this video... 💕❤️ . Every point is clear now . 🙏
We also don’t have words to describe our happiness by seeing this comment . It again affirms that we are on right track . Thank u
Very fruitful discussion.Sir kindly tell us
1) How to calculate amount of blood and how to calculate penumbra size on MRI (DWI/FLAIR) films.
2) Role of Citicoline in acute stroke whether haemorrhagic or nonhaemorrhagic.
3) Prior thrombolysis for very high BP control we usually prefer labetalol by infusion.However what should be route of administration of ACE inhibitors/ARBs in acute stage as I have seen rapid fall in BP after i.v administration of inj.cardace.Please tell us titration as well.
Thank You.
👍... Pls make more videos on more topics which commonly present to ER and ICU like MI, Acute on chronic CKD, Copd, pancreatitis.... Thank u...
Case: A 65 yrs old female pt. had a past history of MI and was on Aspirin-clopidogrel combinations. The pt during visit to the GP was found to have BP 180/100 mm Hg and pulse rate of 90 bpm, accentuated S2 , had SOB . Pt was prescribed S Amlodipine 5mg , Metoprolol XL50mg, Hydrocholorothiazide 12.5 , atorvastatin 20 mg. and after some day telemisartan 40 and GTN 2.6 BD 8 hrly was added. But the pt was not adhering to medication schedule strictly, suffered Haemorrhagic Stroke and was hospitalized. Aspirin-clopidogrel was stopped and after 10 days was discharged with advice not to take Aspirin-clopidogrel or any other anticoagulants . After that the pt again reports to the previous GP for medical care , the GP takes care of her medical situation and slowly on 3 week her subtle neurological deficits too got ameliorated. IN the mean time the GP took advice from 2 Consultant Physicians and they advised not to start the Aspirin-clopidogrel combination for 4-6 months rather increase the dose of the atorvastatin to 40 mg ( previously on 20mg ). After 6 weeks of the CVA the GP found on examination that tremor of extended hands was observed but no blood thinner could be added as per the advice of the Consultants . After another 3 weeks the pt suffered Ischaemic stroke. My question is: 1. How long such blood thinners should be kept stopped? 2. If the INR is below 2.5 can't the anticoagulants be started? Need your detailed comment and directions?
Thank you members of this team
Interesting topic and a Great Team!!!Nice.
Very informative n excellent lecture
Very nicely explain so everyone can understand
Thank you so much sir
For this type of lectures
Wonderful in-depth discussion in a nutshell .
Extra clarity by the neurologist:super sir
Thanks sir. We need more videos Cardiology , critical condition.
Very informative ...
Sir please make class on MI, CKD and copd with asthma also as we r getting these pts on regular basis...thank you for this beautiful video
Thank you sir your lectures is so usefull for me to improve my knowledge thanks alot sir
Excellent video.
Thanks alot for giving such a informative discussion..
Sir.. good info sir....please do details discussion about hemodynamic monitoring and fluid resuscitation in ICU settings..thank you sir
Oh, thanks for bringing nex t generation of Scientists!!
Because of you, i will be one of them.
Currently in my Clinical years of MB ChB. Gulu University, Uganda!
Thank you and welcome to the channel and ESBICM 👍🏼🤝
Thanku so much sir for sharing...
And sir also tell about TIA management in detail..
Thank u such priceless contribution
So nice of you
Thanks sir...nice session 👌👌👌
Really Happy to seeing this high quality discussion such a great thing doing by you sir Thanks to you.
Thank u and welcome
Very good video.. need more from cardiology... watching from Russia..fmge
Need more videos 🙏thanks
Jo medical fraternity actually main sun na chahti wahi content hota hai aapka,
I mean zabasdast!!!
wow, thanks... this reaffirms that we are on right track and its helpful
Great video very helpful thank you so much sir and team
Most welcome
Excellent video thankyou sir ❤
Most welcome, glad you liked it.
Very fruitful, Sir
Thank you 🙏
Welcome!
Thank you sir
Welcome
3 questions were asked in today’s Neet pg exam regarding this topic.Thanks sir
didn't expected that it will be helpful there. but nice to hear that.
Thank you sir
Q-- can we use infusion to lower blood pressure? Which is to be used?
Q -- rTPA, whats the brand name you use? Whats the cost? What are other thrombolytic agents you use and dose?
Yes infusion of labetalol/ nitroprusside can be used
We do use tenecteplase also
kindly discuss MI, AKI, and status asthmaticus...
please make video session about MI.. kindly.
VERY HELPFUL SIR
Glad to hear that
THANK U VERY MUCH FOR YOUR GREAT EFFORTS.SIR 1 REQUEST IT WILL BE BETTER IF U DEMONSTRATE THE TPA PREPARATION LABETALOL, INFUSION PREPARATION, AND OTHER ICU DRUGS INFUSION PREPARATIONS
ya drug section is in consideration .
Sushant boss...big HII from your badminton partner..🙂.a very pleasant surprise to see you here on this platform. .gained a lot !! thankyou
Thanks for ur words, your message conveyed to Dr Sushant 👍🏼
@@TheICUChannel thankyou sir🙏..love this channel 😊
Sir kindly do a video regarding anticerebral edema measures in raised ICP. Role of 3% saline , mannitol & glycerol. Should we give both mannitol & 3% saline simultaneously. For how many days we should give these antiedema measures.
Exallent discussion, can we use neuroprotetve drugs like citicholin
❤❤❤
Waiting for thrombolysis protocol video.
Cect head ki class bi le lo sir radio valo p dependency kam ho jaegi
Bahut bhav khate h
How do I know , this is Ischaemic stroke just on entering the room and seeing the patient, in 1 minutes. Hey from a Consultant view point. I just like this topic!!!!!!❤❤
Not possible or full proof … there may be clues but not reliable.
1st comment ,good info !
thank you, do listen it fully, its good.
@@TheICUChannel yeah ,I am listening to it presently , its very useful !
Sr pls explain about AOSD...
Thank you sir for such a beautiful presentation.
Sir i have a confusion.
One of the patient kco Ckd on MHD(with heparin), was diagnosed with Infective endocarditis. Consultant has done a CT brain due to neurological deficit. Which came to be a large infarct in CT(Left).
Suddenly he told to stop dual antiplatelets(whick patient was receiveing before). When i asked him why he has stopped. He told me since its a large infarct there is a high chance for harmorragic transformation. I want to know sir about the reality.
Sir this is which hospital? I wish to join it for my icu experience post md
Sir, What about giving PPV to reduce RICT and what should be the FiO2??
one video on loading dose of aspirin. what is concept behind this
If AIS pt has chewed 2 tabs of 75mg Asprin(enteric coated) while coming to ED within window period and Ct head is clear, can he receive TPA since pre-TPA he as taken asprin.
And was this Asprin taking practice on any significance for his 1° stroke thrombus to reduce the ischemic core or salvage penumbra?
Sir I agree no role prophylactic AEDs but in my experience if patient goes into seizure the morbidity increases. Sir in remote limited settings and CT not available can we give rTPA because 85% stroke are ischemic. Sir do patient of TIA should be on life long antiplatelets.
Timing of LMWH in non thrombolysis stroke patient ??
Supposing IC bleed occurs can we give inj Trenexamic acid inj
Thank you Sir for the information. Sir, at what dose dual antiplatelets be used. And which antiplatelet should be stopped after 21 days.
ecospirin should be continued.
I personally don't like the whole thrombolysis process, had a pt with MCA infarct, brought well in window period, thrombolysed her, but eventually her GCS deteriorated due to hemorrhage coz her BP was shooting up ... required AntiHTN infusion too... I find it so dicey basically
But thanks to this amazing channel! Healthy discussion! 😊
Loading dose?
Role of citicoline and cerebropoetin
How to differentiate Stroke Vs TIA before deciding to thrombolyse ? (No MRI available).
TIA will show improving symptoms.
Tell me about bp controll and cut off in hemorrhage stroke please
#icushort 110: BP targets in case on intracranial hemorrhagic strokes #esbicm
Hello. I work as an internist in hospital medicine.
Regarding stroke, do you guys call a CODE stroke when an emergency physician suspectes stroke in ED or an inpatient develops stroke like symptoms?
we don't have but we are working on it to implement. but we alert telephonically.
Drugs to control or reduce acutely elevated blood pressure say 240/140 mg. Does Nitroglycerin infusion or SNP infusion or Esmolol infusion have a role. Kindly throw some light.
Sorry 240/140 mm of Hg
Sir if a patient has undergone mitral valve replacmnt surgery and is on warfarin for 6 years and has an ischaemic stroke... Should such person be thrombolysed Or any treatment be done after the window period is over. The patient had blurring vision and drooping of eyelid which subsided in 48hours but blurring vision is dr.. She presented to see her diabetologist after 48 hours of symptoms. The patient is on insulin too.
The mri showed subacute infarct after 5 days on dwi.
After window period , only antiplatelets have a role . Anticoagulants is for mitral valve replacement .
Thank u for the reply.. I did not expect such a quick reply.. I really like the sessions sir.. It helps me build practical concept . Thank u.
The patient is on warfarin but no antiplatelet was started by her neurologist on day 5 on presentation. Also her ct angrio showed no finding except for an anomaly fetal pca.
Sir which notes u r using during video recording
Our complied notes and guidelines
What is the full name of Dr. Sushant. I think he is my batchmate. Is he did his UG from Grant Medical College, Mumbai.
Dr Sushant Aildasani
Sir one question. If patient has passed window period but still if we want to thrombolysis patient then can we do it? If yes then til what maximum period? Also sir if a pontine infarct or any posterior circulation infarct patient comes after window period can we refer patient for machanical thrombectomy???Many patient past window do come sir
Thankyou sir
That’s what is discussed in the video … listen one more time , if still in doubt , ask again .
I mean to ask sir is there any exceptions to window period? Like pontine infarct young male presenting at 7hrs from first symptoms. Any Risk benefit ratio sir or we have to strictly stick to 4.5hr
@@mansigupta11 posterior circulation stroke always a priority as it makes patient too dependent and mornid , but per se there is no exception. It all depends of CT perfusion / MRI diffusion and flair mismatch and availability Interventinal neurological team .
@@TheICUChannel thankyou sir
Its a silly question, but is 4.5 hr 4hr 50min OR 4 hours and 30min.
4 hours 30 min .
Thankyou
Sir please let us know the hospital name? I wish to do my SRship with you
It’s not the way i am on the channel . Routine hours are busy so not able to give enough time on regular days . So don’t want u to disappoint if u join . Keep learning
Okay sir 😇🙏
@@preetijoon7295 once I feel our routine classes in Hopsital have become regular , will invite applications .
Thank you so much sir 😇