Diagnosis awal dan
penanganan awal stroke
Eko Arisetijono
Departemen/SMF Neurologi
Fakultas Kedokteran/RS Saiful Anwar
Malang
Stroke is defined by the World Health Organization7as 'a
clinical syndrome consisting of rapidly developing clinical signs
of focal (or global in case of coma) disturbance of cerebral
function lasting more than 24 hours or leading to death with
no apparent cause other than a vascular origin.'
STROKE
Stroke Facts
During a Stroke ,your patient’s brian is
dying
Two million neurons per minute or
minimum 33.000 per second are lost until
reperfusion achieved
Every 15 minutes gives the patient a 4%
greater chance of independence discharge
Pendahuluan
Stroke penyebab Stroke bisa diobati
Stroke penyebab
kecacatan tertinggi dengan
kematian
pada usia penanganan yang
terbanyak
produktif cepat dan tepat
Kecacatan pada
Stroke bisa stroke bisa di tata
dicegah laksana dengan
baik
Vascular
Perspective
This Photo by Unknown Author is licensed under CC BY-NC-ND
Type of Stroke
100ml/cm3/min 50-100ml/cm3/min
<20ml/cm3/min
20-50ml/cm /min
3
(necrotic
cell death)
(apoptosis :programmed
cell death) Caspase
Neuroplastisitas
Neurorestorasi
Berdasarkan
hal tsb
Diagnosis dini dan
penanganan dini menjadi
sangat penting
Langkah
langkah yang
harus
dilakukan
Pertolongan pasien stroke harus dikerjakan sejak pasien
mempunyai gejala
This Photo by Unknown Author is licensed under CC BY
AHA recommendations to EMS
DISPATCH TIME OF LESS EMS RESPONSE TIME LESS ON-SCENE TIME LESS
THAN 90 SECONDS THAN 8 MINUTES THAN 15 MINUTES
Jauch EC, Saver JL, Adams HP, Jr., et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke.
2013;44:870-947.
Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311:1632-40.
Berglund A, Svensson L, Sjostrand C, et al. Higher prehospital priority level of stroke improves thrombolysis frequency and time to stroke unit: the Hyper Acute Stroke Alarm (HASTA) study. Stroke. 2012;43:2666-70.
Mosley I, Nicol M, Donnan G, et al. The impact of ambulance practice on acute stroke care. Stroke. 2007;38:2765-70.
Patel MD, Brice JH, Moss C, et al. An evaluation of emergency medical services stroke protocols and scene times. Prehosp Emerg Care. 2014;18:15-21.
Nancy K. Glober et AlAcute Stroke: Current Evidence-based Recommendations for Prehospital Care Western Journal of Emergency Medicine 104 Volume XVII, no. 2 : March 2016
1. Diagnose stroke
1. Diagnosing stroke
Gejala Stroke
This Photo by Unknown Author is licensed under CC BY-SA-NC
Face ,Arm,Speech,Time
Yg terpenting setiap ada gejala mendadak harus dicurigai sbg stroke
Dan ada gejala gangguan fungsi otak (tgt lokasi otak yang terkena)
1. Diagnose stroke
2. Choose hospital
1. Diagnose stroke
3. Emergency transport
1. Diagnose stroke
4. Pre-notification
Pre-notification
STUDIES HAVE SHOWN:
SHORTER SYMPTOM ONSET TO
HOSPITAL ARRIVAL
INCREASE IN THE AMOUNT OF
PATIENTS WITH DOOR-TO-
IMAGING TIMES WITHIN 25 MIN
LOWER ONSET TO DOOR TIMES
OBSERVED (113 MIN VS. 150 MIN)
Lin, C. B., Peterson, et al. (2012). Emergency Medical Service Hospital Pre-Notification is Associated with Improved Evaluation and Treatment of Acute
Ischemic Stroke. Journal of the American Heart Association , 1-9
Do as much as possible before hospital arrival
Oxygen saturation Blood pressure IV access Glucose test Pre-admit patient
Leaving as little as
possible to be done
after hospital arrival
Deliver directly to CT scanner
Dx pasti
Ditegakkan secara klinis oleh Dokter yg
kompeten
Pemeriksaan penunjang dari yang paling
sederhana sampai yang paling canggih
Neurointervention
Vascular Study (DSA)
Membuat sistem
emergensi stroke
• Pertolongan pertama di tempat kejadian
• Sistem ambulance yang baik
• Sistem penapisan sejak pasien mengalami gejala
untuk memilih rumah sakit yang tepat
• Tindakan emergensi stroke sejak di ambulance
dan pemilihan rumah sakit This Photo by Unknown Author is licensed under CC BY-ND
• Koordinasi dengan rumah sakit yang dituju
• Jalur prioritas di rumah sakit
Kesimpulan
• Diagnosis dini
• Pertolongan pertama sejak pasien
mengalami gejala
• Penting untuk menyelamatkan
nyawa
• Penting untuk mencegah dan
memperbaiki kecacatan pasca stroke
• Harus ada system
• Tindakan keperawatan harus terlibat
sejak awal
This Photo by Unknown Author is licensed under CC BY-ND
Terima kasih
