Acute treatment of stroke with medications | NCLEX-RN | Khan Academy

Aug 26, 2023

Acute treatment of stroke with medications | NCLEX-RN | Khan Academy

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Content

1.712 -> - [Voiceover] After you start to recognize

3.623 -> that someone might be having a stroke, right,

6.27 -> maybe they have some of the symptoms

7.826 -> we know to be common stroke symptoms,

9.831 -> like maybe one side of their face starts to droop.

13.027 -> Or maybe all of a sudden they have some vision loss

15.424 -> or some numbness or weakness on one side of their body.

18.413 -> Then you want to make sure that this person

20.44 -> gets to the hospital as quickly as possible

24.027 -> because remember more than any organ in the body,

27.371 -> our brains love oxygen.

29.837 -> Brain tissue cannot live without it even for a few minutes,

32.948 -> so in a stroke when blood stops flowing

36.229 -> to a part of the brain

37.392 -> and thus deprives the brain of the oxygen it carries,

40.935 -> the brain tissue that's missing out on oxygen

43.676 -> starts to die off.

45.882 -> So super important that whoever you're suspecting

48.271 -> of having a stroke is taken to the hospital

50.562 -> as quick as possible to save as much brain as possible.

54.565 -> So now that we're at the hospital,

56.191 -> what goes on there, what's gonna happen?

59.226 -> A few things are gonna happen.

60.804 -> I mean the plan is to diagnose the stroke, right,

63.356 -> with some tests and some imaging,

65.771 -> and then to treat the stroke with some medications.

68.908 -> So let's take a look.

70.626 -> We know that part of diagnosis includes a physical exam

73.761 -> to look for any physical signs

75.386 -> that the person has had a stroke.

77.592 -> Really importantly, it also includes imaging

79.967 -> like CT and MRI scans.

82.997 -> It includes lab tests, blood work to look for

85.771 -> an underlying cause of the stroke

87.367 -> or to rule out other diagnoses

89.201 -> like hypoglycemia, which can look like a stroke.

92.638 -> The kind of treatment that the person gets

94.886 -> really depends on the type of stroke that they had.

97.924 -> Let me show you what I mean here.

99.944 -> You could've had an ischemic stroke, for example,

103.984 -> where a clot blocks off a bit of blood vessel in the brain

106.771 -> and causes a stroke that way.

108.977 -> Or you could've had a hemorrhagic stroke, for example,

112.436 -> where a weakened blood vessel in the brain starts to leak,

115.965 -> maybe because of a ruptured aneurysm

118.171 -> or some trauma to the head,

119.68 -> like from a fall or something unpleasant like that.

122.769 -> But how does the type of stroke

124.083 -> you have influence treatment?

126.312 -> Because for ischemic strokes,

129.402 -> which you can usually identify on imaging,

132.49 -> actually let me clarify that.

134.338 -> You won't be able to see any brain changes on CT scan

137.483 -> right after a patient's had an ischemic stroke.

140.524 -> That's why this CT up here looks pretty normal.

143.45 -> But the key is that it doesn't look like

145.569 -> a hemorrhagic stroke CT scan,

147.699 -> which I'll show you in a few minutes.

149.998 -> So the patient in whom you're suspecting an ischemic stroke

154.137 -> gets certain medications that you

156.317 -> definitely do not get in hemorrhagic stroke.

160.085 -> Let me show you what I mean here.

162.757 -> Let me bring up a blood vessel here

164.336 -> to just show you how these medications work.

167.29 -> If the patient had an ischemic stroke

170.43 -> and came to the hospital quickly enough,

173.603 -> they'd often be given two types of medication.

177.363 -> One is aspirin, and aspirin doesn't actually do anything

180.692 -> about the existing clot.

182.42 -> It can't break it up or anything like that,

184.277 -> but what it can do, what it can do

187.341 -> is prevent new clots from forming.

190.314 -> So it stops platelets in your blood from working properly

193.495 -> because platelets in your blood are responsible

195.592 -> for forming the initial component of a blood clot.

200.051 -> It stops those from forming.

202.952 -> Really importantly, you might be given a type of medication

206.342 -> called a thrombolytic.

208.688 -> This thrombolytic is the one that can potentially

211.431 -> break up that clot that's causing the stroke, right?

214.729 -> You might have heard of clot-busting medication

217.233 -> and this would be type of that.

219.314 -> Thrombo means clot and lytic means to break something up.

223.828 -> This one in particular is called

225.675 -> tissue plasiminogen activator or TPA.

229.407 -> That sounds like a pretty confusing name

231.751 -> but it's called tissue plasminogen activator

234.532 -> because of what it does.

236.018 -> It activates a compound called plasminogen

240.197 -> that's already naturally found floating around in your blood

242.844 -> as part of the body's natural mechanism

245.305 -> to break up any clots that shouldn't be hanging around.

249.36 -> So TPA sort of kick starts this natural system

252.48 -> already in your bloodstream to try to bust up

254.662 -> the clot that causes the stroke, right?

257.727 -> Actually when plasminogen gets activated by TPA,

261.085 -> it turns into this compound called plasmin

263.741 -> and that's what's actually doing the busting up,

265.754 -> the clot busting, that's why I wrote plasmin here.

268.636 -> Really importantly about this drug,

270.188 -> the benefit of TPA is the highest

272.956 -> right after the stroke has occurred,

275.266 -> and then it just kinda gets

276.481 -> less and less effective from there.

278.315 -> Again, I'm just trying to highlight the fact

280.226 -> that the earlier the patient gets to the hospital,

282.75 -> the better the outcome,

284.283 -> the better the TPA will work.

286.721 -> That's ischemic strokes.

288.222 -> That's acute management of an ischemic stroke.

292.469 -> With hemorrhagic strokes though it's a different story

295.163 -> because when you have vessels that are bleeding out,

298.723 -> the first thing you want is for it

301.015 -> to clot off and stop bleeding,

303.245 -> and therefore the last thing you want is

305.458 -> to activate your plasminogen clot-busting system.

308.701 -> You won't be given TPA

310.443 -> because if you are given TPA,

312.347 -> then your blood will be far less likely to clot, right,

315.528 -> as we saw earlier.

316.968 -> Blood will just continue to pour out

318.524 -> of this deficiency in the blood vessel here, see?

321.589 -> Actually let me bring up a CT scan

323.483 -> of a hemorrhagic stroke.

325.443 -> You remember I said I was gonna bring one up.

327.918 -> You can see all of this blood here.

330.116 -> This bright spot is a big collection of blood

332.548 -> that's been sort of leaking out of blood vessels

335.073 -> in the brain that have ruptured.

338.692 -> You can see that this looks really different

341.262 -> from the CT scan over here on the left

343.599 -> of an ischemic stroke.

346.052 -> This is why brain scanning is super important

349.544 -> when you're diagnosing a stroke

351.587 -> 'cause it really has big implications

353.761 -> on how you treat the stroke afterward.

356.408 -> For hemorrhagic strokes the focus of initial treatment

359.372 -> has to be a little different than with ischemic strokes.

362.99 -> For example, with hemorrhagic strokes

365.219 -> it's really important to find out

366.659 -> which blood vessel's bleeding,

368.418 -> so where exactly in the brain the bleed is.

371.343 -> That can be done by the imaging tests like CT

374.392 -> or MRI or angiography that we talked about.

377.781 -> Because the goal is to stop the bleed,

380.622 -> it's important to first know where it is.

383.4 -> Another thing, anytime you're bleeding

385.805 -> from a vessel, right, losing blood,

388.508 -> your heart starts to get a little worried, right?

391.497 -> Good ol' heart always looking out for you.

394.126 -> It starts to pump blood out a little harder

396.519 -> and it's thinking that that's what it'll take

398.602 -> to get blood going everywhere again.

401.04 -> Now your blood pressure's gone up.

403.223 -> But there's two main drawbacks to that.

405.591 -> One is that if a little clot has started to form, right,

408.931 -> to seal up the initial tear in the blood vessel,

412.089 -> is that new maybe not so stable clot

414.866 -> gets hit with blood racing along at high pressure,

418.047 -> it might get dislodged and rebleeding might happen.

421.771 -> The second drawback to blood pressure that gets too high is,

426.108 -> let's say that a clot hasn't formed

427.961 -> and it's still bleeding, it's still active.

431.384 -> Then now blood'll just start coming out

433.705 -> of the vessel even faster, right,

435.679 -> and that's probably the last thing that we want.

438.233 -> The patient might be given antihypertensives

440.764 -> or blood pressure lowering drugs

442.32 -> to try to keep the blood pressure from getting too high.

446.058 -> It's also really important with hemorrhagic strokes

448.286 -> that the healthcare team stops or reverses the effects

451.38 -> of any medication that the patient's regularly taking

454.215 -> that might increase bleeding,

456.004 -> such as warfarin or the aspirin that we mentioned earlier.

459.982 -> Also really important is that pressure building up

463.375 -> in the brain and the skull

464.796 -> from all this blood is controlled.

467.742 -> For starters one simple way to do that is to just make sure

470.855 -> that the head of the patient's bed is elevated.

473.702 -> This works just because of good ol' gravity.

475.709 -> When the patient's head is elevated,

477.938 -> then more blood will flow out of the head

480.304 -> in the jugular veins, right?

482.642 -> That's one way of lowering pressure in the head a bit.

485.931 -> One reason why keeping pressure in the head

488.529 -> at a normal-ish level is really important is that

491.683 -> when your brain starts to get pushed on or compressed,

495.318 -> it kinda disrupts the normal electrical activity

498.322 -> in the brain and you could end up having a seizure.

500.833 -> So the doctors might consider giving an anticonvulsant,

505.336 -> which is a medication to prevent seizures from happening.

509.267 -> Another reason is just because

510.714 -> some pretty vital areas in your brain,

512.65 -> particularly your brain stem,

514.415 -> they might get compressed

515.971 -> with all of this pressure building up

517.805 -> and that's pretty quickly fatal so we don't want that.

522.635 -> There are some other surgical ways

524.234 -> to keep pressure under control

526.198 -> but we won't focus on that right now.

528.08 -> But you can definitely start to see

529.426 -> that management of hemorrhagic stroke

531.145 -> is really about managing the patient

532.909 -> until interventions like surgery can happen.

535.672 -> Whereas with ischemic strokes,

537.53 -> while you might still need

539.037 -> more invasive treatment down the line,

541.733 -> at least you can give TPA initially

543.929 -> to try to get things resolved beforehand,

546.121 -> try to bust up that clot

547.282 -> before you need more invasive treatment.

551.243 -> So that's a quick look at

553.016 -> some of the immediate management

554.796 -> of ischemic and hemorrhagic strokes.

Source: https://www.youtube.com/watch?v=LvoONWiXJ5I